Background-Referral for fetal echocardiography is an acute stressor that may induce significant maternal anxiety. To promote good clinical management of expectant mothers in this situation, including adequate screening for possible psychiatric interventions, data is needed regarding the psychosocial functioning of women scheduled for fECHO procedures.

Background: Women awaiting fetal echocardiography (fECHO) report high anxiety. It is unclear if anxiety decreases after performance of fECHO. Methods: At fECHO, subjects’ current (state) vs baseline (trait) anxiety was assessed using the Spielberger State-Trait Anxiety Inventory. Anxiety scores of the pre- and post-fECHO groups were compared. Results: From January 2007 to January 2009, we recruited 84 subjects: 40 pre-fECHO and 44 post-fECHO. Of the post-fECHO group, 30 had normal fetal cardiac structure and function confirmed, 12 were told of an abnormality, and 2 were told to follow up equivocal results. Anxiety scores were compared between the 40 pre-fECHO subjects and the 30 post-fECHO subjects with normal results. The mean state anxiety score of the pre-fECHO group was higher than that of the post-fECHO group (42.1 ± 15.1 vs 30.8 ± 8.5, p < 0.001); there was no difference in trait scores. Neither state nor trait anxiety was associated with maternal age, parity, history of miscarriage or known fetal anomaly. Compared to those with a normal fECHO (N = 30), subjects with an abnormal fECHO result (N = 12) had higher state anxiety (46.8 ± 15.5 vs 30.8 ± 8.5, p = 0.005). There was no difference in anxiety scores between subjects awaiting fECHO and post-fECHO subjects who had an abnormal result. Conclusion: Immediately following normal fECHO, women report low anxiety compared with women awaiting fECHO. Women awaiting fECHO report anxiety levels that are as high as women who are told there is fetal cardiac anomaly

Results: Mean maternal age was 32 ± 5 years (21-42 years) and gestational age at the time of the fetal echocardiogram was 25 ± 6 weeks (19-31 weeks). Out of 18 fetuses with a NT of 2 mm or more, 9 had a VSD (7 muscular and 2 perimembranous) (50%), while in only 12 out of 167 fetuses with a NT < 2,0 mm a VSD was detected (9 muscular and 3 periembranous) (7%). This association was significant (p < 0.001), with a relative risk of 7.8 (95% CI: 3.5-17.5). Conclusions: Fetuses without chromosome abnormalities with a first trimester NT of 2mm or more have an 6.8-fold increase in the risk of presenting an isolated ventricular septal defect. We speculate that the defects could have been larger and functionally important in the first trimester, increasing the NT as a consequence of hemodynamic overload and gradually decreasing its diameter until the second and third trimesters. This knowledge may have implications in prenatal management and counseling.

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