Utility of Screening Fetal Echocardiogram Following Normal Anatomy Ultrasound for In Vitro Fertilization Pregnancies

Area of Science:

• Cardiology
• Reproductive Medicine
• Prenatal Diagnosis

Background:

• In vitro fertilization (IVF) pregnancies have a higher risk of congenital heart disease.
• Universal screening fetal echocardiograms (F-echo) are often performed, even with normal obstetric scans (OB-scan).
• The added benefit and cost-effectiveness of screening F-echo in IVF pregnancies with normal OB-scans are debated.

Purpose of the Study:

• To determine the diagnostic utility of screening F-echo in IVF pregnancies.
• To assess the impact of normal cardiac anatomy on OB-scan on F-echo findings.
• To evaluate the influence of interpreting physician subspecialty and OB-scan view completeness on F-echo accuracy.

Main Methods:

• Retrospective chart review of 525 IVF pregnancies referred for F-echo (2014-2020).
• Analysis of OB-scan reports for cardiac anatomy (4-chamber, outflow tract, supplemental views).
• Review of F-echo results and postnatal outcomes, categorized by interpreting physician subspecialty (Obstetrics, MFM, Radiology).

Main Results:

• Of 411 reviewed OB-scans, 304 (74%) showed normal cardiac anatomy.
• F-echo was normal in 91% of cases with normal OB-scans; none of the abnormal F-echoes required intervention.
• OB-scan accuracy for normal anatomy was high (91-92%) regardless of supplemental views or interpreter subspecialty (95% OB, 85% MFM, 92% Rads).

Conclusions:

• Screening F-echo may offer limited additional benefit in IVF pregnancies when OB-scans demonstrate normal cardiac anatomy.
• The interpretation subspecialty and completeness of OB-scan views did not significantly alter F-echo accuracy for normal findings.
• Cost-benefit analysis of routine screening F-echo in IVF pregnancies with normal OB-scans should be considered.