CONGENITAL HEART DISEASE

Clinical impact of first and early second trimester fetal echocardiography on high risk pregnancies

J S Carvalho^1,*, G Moscoso³, A Tekay³, S Campbell³, B Thilaganathan³, E A Shinebourne²

¹ Brompton Fetal Cardiology, Royal Brompton Hospital, London, UK
² Brompton Paediatric Cardiology, Royal Brompton Hospital
³ Fetal Medicine Unit, St George’s Hospital, London, UK

Correspondence to:
Correspondence to:
Dr Julene S Carvalho
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; j.carvalho{at}rbh.nthames.nhs.uk

Objective: To evaluate the clinical impact of fetal echocardiography before 16 weeks’ gestation on the management of pregnancies with fetuses at risk of congenital heart disease.

Design and setting: Observational study in a fetal medicine unit.

Participants and methods: 222 consecutive women with high risk pregnancies (230 fetuses) underwent transabdominal fetal echocardiography at a median gestation of 14⁺¹ weeks. For 10%, transvaginal scans were also performed. Criteria for normal scans were normal sequential segmental analysis, symmetrical four chamber view, normal semilunar valves, arterial outflow tracts, and ductal and aortic arches. Early scans were compared with mid-second trimester fetal echocardiography. Postmortem and postnatal data were added. Adverse pregnancy outcomes were diagnosis of a major cardiac or extracardiac abnormality, chromosomal defects, intrauterine death, or termination of pregnancy.

Results: There were 21 abnormal cardiac scans (9%): 14 major structural defects (eight isolated, six with chromosomal or extracardiac abnormalities) in pregnancies resulting in three live births, one intrauterine death, and 10 terminated pregnancies. Seven scans showed asymmetry between right and left sided structures (two isolated, five with chromosomal or extracardiac abnormalities); six of the seven pregnancies were terminated. The scans were normal in 199 cases (87%). Cardiac follow up of 184 of 199 babies (93%) confirmed situs and connections. One case each of pulmonary stenosis and ventricular septal defect requiring postnatal intervention were diagnosed at later scans. In 28 of 199 (14%) babies there was a non-cardiac adverse outcome. First examination was not diagnostic for 10 (4%).

Conclusion: Early fetal echocardiography in high risk pregnancies was diagnostic in 96%. Abnormal cardiac scans (isolated in 48%, major structrual defects in 67%) led to termination of pregnancy in 76%. Most cardiac scans were normal, allowing family reassurance. The high number of adverse outcomes with normal cardiac anatomy stresses the need for a multidisciplinary approach to early fetal echocardiography.

Abbreviations: AVSD, atrioventricular septal defect; CHD, congenital heart disease; NT, nuchal translucency; VSD, ventricular septal defect

Keywords: echocardiography; heart defects; congenital heart disease; diagnosis; pregnancy

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Pathak, S, Lees, C (2009). Ultrasound structural fetal anomaly screening: an update. Arch. Dis. Child. Fetal Neonatal Ed. 94: F384-F390 [Abstract] [Full Text]  
• Smrcek, J. M., Berg, C., Geipel, A., Fimmers, R., Diedrich, K., Gembruch, U. (2006). Early Fetal Echocardiography: Heart Biometry and Visualization of Cardiac Structures Between 10 and 15 Weeks' Gestation. J Ultrasound Med 25: 173-182 [Abstract] [Full Text]  
• Smrcek, J. M., Berg, C., Geipel, A., Fimmers, R., Axt-Fliedner, R., Diedrich, K., Gembruch, U. (2006). Detection Rate of Early Fetal Echocardiography and In Utero Development of Congenital Heart Defects. J Ultrasound Med 25: 187-196 [Abstract] [Full Text]