Fetal echocardiography in an Arab population: indications and findings from a tertiary care center

This study aimed to evaluate the indications and common findings of fetal echocardiography at a tertiary care center in Saudi Arabia, as well as identify factors associated with abnormal findings. We conducted a retrospective analysis of fetal echocardiograms performed over five years at a high-volume referral center. Indications were categorized as maternal factors (e.g., diabetes, family history of CHD) or fetal factors (e.g., abnormal ultrasound, extracardiac anomalies). These factors were also evaluated using null hypothesis significance testing to assess their association with abnormal outcomes. Among 968 referrals, fetal indications (38%),was the most common reason for echocardiography referral, followed by maternal conditions (25%). These indications were also associated with abnormal echocardiography findings (p < 0.001). Of the abnormal findings, the most prevalent CHD subtypes were complex anomalies (24.3%) and ventricular septal defects (16.1%). In this study population, being indicated for fetal anomalies predicted abnormal echocardiography findings, supporting their prioritization in referral guidelines. Maternal factors had a less pronounced value, suggesting opportunities to refine screening criteria. These findings highlight the need for region-specific protocols to improve CHD detection in Arab populations.