A study on referral pattern for fetal echocardiography and identifying the various risk factors for congenital heart defects

Abstract

Background: Fetal Echocardiography is becoming an important tool for the detection of CHD but results can be unpredictable, depending on various factors like expertise, position of the baby and referral indications. Various factors are associated with detection of CHD which need further evaluation. The present study was undertaken to study the referral pattern for Fetal Echocardiography (FE) at a tertiary Pediatric Cardiac Centre and further to identify the various risk factors associated with Congenital heart defect. Results: The study was conducted on 200 consecutive pregnant women who were referred for fetal echocardiography at Pediatric Cardiac Unit of the hospital. The mean maternal age and the mean gestational age were 26.85 ± 4.6 years and 30.36 ± 5.14 weeks at the time of fetal screening. On evaluating the various referral indications, gestational diabetes mellitus was found in 55% of the study subjects, but CHD was detected in 3.6% of their fetuses. Hypothyroidism was the second commonest indication (16.5%) among the referrals and 3% of their foetuses were found to have CHD. The indication that accounted for the maximum number of CHD (50%) was cardiac anomaly detected on ultrasonography, followed by single umbilical artery, in which 33.3% of CHD was detected. CHD was however significantly associated only with the referral indications of cardiac anomaly on USG (p value < 0.001) and single umbilical artery (p value = 0.033). The association of the other referral indications of the subjects was not found to be significant. Conclusion: Majority of women referred late for the fetal echocardiography screening. Extracardiac anomaly during second trimester scan warrants immediate fetal cardiac evaluation