Fetal echocardiography: A single-center tertiary care experience

Abstract

Background: Although fetal echocardiography is established screening tool for the detection of cardiac anomalies, its utility and awareness remains less in less-developed areas of the world. There is no data from our region about the usage and outcome of fetal echocardiography. Aims and Objectives: To study the indications, referral patterns, and outcomes of fetal echocardiography. Materials and Methods: All pregnant women referred for fetal echocardiography from January 2017 to July 2018 were included in the study. Results: A total of 600 pregnant women underwent fetal echocardiography. The mean age of patients was 28 ± 4.2 years. The mean gestational age referred for fetal echo was 26 ± 4 weeks. Four hundred and twenty (70%) patients were more than 22 weeks of gestational age. Indications included maternal indications in 385 (64.2%) patients. The various maternal indications included bad obstetrical history in 180 (30%), pregestational diabetes in 100 (16.67%), congenital heart disease (CHD) in mother in 35 (5.83%), medication use during pregnancy in 15 (2.3%), and connective tissue disorder in mother in 55 (9.16%). Other indications included abnormal/not properly visualized cardiac chambers on anomaly scan in 50 (8.3%) and previous child with heart disease in 105 (17.5%). Different abnormalities detected included ventricular septal defect, pulmonary atresia intact septum each in 3 (0.5%); tetarology of fallot (TOF), tricuspid atresia, unbalanced atrioventricular canal defect with single ventricle, corrected the great arteries, fetal cardiac tumor, Ebstein anomaly, and total anomalous pulmonary venous connection each in 1 (0.16%); double outlet right ventricle pulmonary stenosis, hypoplastic left heart syndrome, compete heart block, fetal supraventricular tachycardia, and CoA each in 2 (0.33%) patients. Twenty-four of 600 (40 per 1000) screened fetal echos were abnormal. Seventeen (70.8%) patients were referred for an unsatisfactory/abnormal anomaly scan which were low-risk pregnancies. The highest yield of CHD was in patients who had been referred for abnormal fetal anomaly scan when compared with other referral indications (17 of 50 [34%] versus 7 of 550 [1.27%] in other indications; P = 0.0001). Conclusion: The most common indication for which fetal scan was abnormal routine ultrasound which was mostly low-risk pregnancies. Dedicated cardiac screening should be part of the routine anomaly scan. Detailed fetal echo should be done in all patients who have any doubt on anomaly scan. Greater awareness in our community is needed for proper referral timings of fetal echo.

Keywords

• congenital heart diseases
• fetal echo
• referral patterns