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Maternal diabetes mellitus: which views are essential for fetal echocardiography?
R S Smith1, C H Comstock, R P Lorenz
1Division of Fetal Imaging, William Beaumont Hospital, Royal Oak, Michigan, USA. rssmith@beaumont.edu
Objective:
To determine which fetal echocardiography views are essential to detect the majority of cardiac defects in fetuses of women with diabetes mellitus.
Methods:
Fetal echocardiograms performed from February 1990 through May 1996 on insulin-requiring women with diabetes were reviewed. Individual component views of the examination were analyzed for the detection of fetal congenital heart defects. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Multiple gestations and patients with additional risk factors for congenital heart defects were excluded.
Results:
A total of 223 patients were included in the study. There were 11 (4.9%) congenital heart defects, eight of which were conotruncal. When the four-chamber view and outflow tracts appeared normal, additional views such as the ductal and aortic arches did not detect a cardiac defect. The sensitivity of the four-chamber view for detecting an abnormal heart increased from 73% to 82% with the addition of the aortic outflow tract. There were two false-negative and no false-positive diagnoses.
Conclusion:
The four-chamber and outflow tracts are the essential views that will detect most cardiac defects in fetuses of women with insulin-requiring diabetes mellitus.