Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography

Quarello, E.; Lafouge, A.; Fries, N.; Salomon, L. J.

doi:10.1002/uog.15866

Cited by 53 publications

(57 citation statements)

References 23 publications

(35 reference statements)

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“…However, experienced operators using a combination of color Doppler assessment of the four chamber and three vessel and trachea view, a 89% sensitivity and 100% specificity was achieved (Wiechec et al, ). Similarly, Quarello et al investigated implementation of early fetal cardiac screening in a low‐risk setting (mainly utilizing transabdominal scanning) and found that the incorporation of the four‐chamber view and three vessel and trachea view with color or directional power Doppler during the routine first trimester ultrasound (between 11 + 0 and 13 + 6 weeks of gestation) yielded a sensitivity of 89% and specificity of 100% for detection of major congenital heart disease (Quarello, Lafouge, Fries, Salomon,, & CFEF, ). Following a brief training period, it was possible to obtain a satisfactory normal four chamber view in 86%, three vessel‐trachea view in 79% and both in 73% (Quarello et al, ).…”

Section: Screening the Fetal Heart In Early Pregnancymentioning

confidence: 99%

Early fetal echocardiography

McBrien

Hornberger

2018

Birth Defects Research

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Objectives To explore the technical aspects and clinical utility of early fetal echocardiography and screening of the fetal heart in early pregnancy. Also, to document differences in cardiac structure and function which can be demonstrated in the late first/early second trimesters. Methods In addition to summarizing our own experiences of late first/early second trimester fetal echocardiography, we reviewed the literature to explore clinical indications for, technical aspects, safety, accuracy, strengths and weaknesses of early fetal echocardiography. Results In the current era, an increasing number of fetuses are identified as being at risk of congenital heart disease from as early as the late first trimester. In experienced hands, early fetal echocardiography can pick up a high proportion of congenital heart disease with good reliability for the majority of lesions. Early fetal echocardiography is relatively poor at assessing pulmonary veins, the atrioventricular valves and lesions that typically occur later or progress during the course of pregnancy. There is increasing interest in widespread implementation of an early obstetric anomaly screen which includes an assessment of the fetal heart for all pregnancies. There are a variety of hemodynamic differences in the late first/early second trimester compared with later in pregnancy. Conclusion Early fetal echocardiography is has become an established tool for detection of congenital heart disease. It affords opportunities to learn about the true spectrum and progression of congenital heart disease in‐utero. Operators should be mindful of safety issues, technical aspects and hemodynamic findings which differ when performing echocardiograms at this stage of pregnancy.

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Section: Screening the Fetal Heart In Early Pregnancymentioning

confidence: 99%

Early fetal echocardiography

McBrien

Hornberger

2018

Birth Defects Research

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“…Previous studies have shown the feasibility of fetal heart assessment in low‐ or high‐risk pregnancies . We hypothesized that in obese women, fetal cardiac landmarks can be assessed with use of a standard technique during NT scan.…”

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confidence: 99%

“…Previous studies have shown the feasibility of fetal heart assessment in low-or high-risk pregnancies. 3,14 We hypothesized that in obese women, fetal cardiac landmarks can be assessed with use of a standard technique during NT scan. The purpose of this study was to show the feasibility of a standardized fetal heart examination in the evaluation of fetal cardiac landmarks in obese women around the time of NT scan.…”

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confidence: 99%

Applicability of Standardized Early Fetal Heart Examination in the Obese Population

Asoğlu

Yao

Seger

et al. 2018

J of Ultrasound Medicine

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Objective This study aimed to evaluate the impact of obesity on early evaluation of fetal cardiac landmarks using a standardized examination method at the time of nuchal translucency scan. Methods This was a cross‐sectional study of an ongoing prospective cohort at high risk for congenital heart defects. We used a standardized examination protocol using 2‐dimensional sonography with power Doppler in the evaluation of fetal cardiac landmarks consisting of 4‐chamber view, outflow tract relationship, and transverse arches view. The study population was stratified based on maternal body mass index into nonobese (<30 kg/m2) and obese (≥30 kg/m2). Groups were compared in terms of satisfactory evaluation of fetal cardiac landmarks, transvaginal sonography use, and scan times required for the evaluations. Subanalysis was performed by further categorizing obesity into nonmorbid obesity (30.0–39.9 kg/m2) and morbid obesity (≥40 kg/m2). Results A total of 190 patients were evaluated. Of these, 48.4% (n = 92) were obese. The most common indication for fetal cardiac assessment was maternal pregestational diabetes mellitus (42.6%). Transvaginal sonography was utilized in one nonobese woman (1.4%) and 11 obese women (12%) (P = .002). The satisfactory evaluation of 4‐chamber view, outflow tract relationship, transverse arches view, and all views were not significantly different between groups (P > .05). The scan time was about 5 minutes longer in the obese group compared with nonobese group (P = .020). Conclusions Obesity does not hamper early evaluation of fetal cardiac landmarks around the time of nuchal translucency scan. However, obese patients are more likely to require transvaginal examinations.

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“…The combination of an NT > 95th percentile with an abnormal ductus venosus and/or tricuspid regurgitation can increase the detection rate for severe heart defects to > 50 % [28]. This marker screening for severe heart defects is increasingly being replaced by the integration of the four-chamber view and the three-vessel view into the detailed first-trimester examination [29,30].…”

Section: Early Diagnosis Of Anomaliesmentioning

confidence: 99%

DEGUM, ÖGUM, SGUM and FMF Germany Recommendations for the Implementation of First-Trimester Screening, Detailed Ultrasound, Cell-Free DNA Screening and Diagnostic Procedures

Kozlowski¹,

Burkhardt

Gembruch³

et al. 2018

Ultraschall in Med

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First-trimester screening between 11 + 0 and 13 + 6 weeks with qualified prenatal counseling, detailed ultrasound, biochemical markers and maternal factors has become the basis for decisions about further examinations. It detects numerous structural and genetic anomalies. The inclusion of uterine artery Doppler and PlGF screens for preeclampsia and fetal growth restriction. Low-dose aspirin significantly reduces the prevalence of severe preterm eclampsia. Cut-off values define groups of high, intermediate and low probability. Prenatal counseling uses detection and false-positive rates to work out the individual need profile and the corresponding decision: no further diagnosis/screening - cell-free DNA screening - diagnostic procedure and genetic analysis. In pre-test counseling it must be recognized that the prevalence of trisomy 21, 18 or 13 is low in younger women, as in submicroscopic anomalies in every maternal age. Even with high specificities, the positive predictive values of screening tests for rare anomalies are low. In the general population trisomies and sex chromosome aneuploidies account for approximately 70 % of anomalies recognizable by conventional genetic analysis. Screen positive results of cfDNA tests have to be proven by diagnostic procedure and genetic diagnosis. In cases of inconclusive results a higher rate of genetic anomalies is detected. Procedure-related fetal loss rates after chorionic biopsy and amniocentesis performed by experts are lower than 1 to 2 in 1000. Counseling should include the possible detection of submicroscopic anomalies by comparative genomic hybridization (array-CGH). At present, existing studies about screening for microdeletions and duplications do not provide reliable data to calculate sensitivities, false-positive rates and positive predictive values.

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Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography

Cited by 53 publications

References 23 publications

Early fetal echocardiography

Early fetal echocardiography

Applicability of Standardized Early Fetal Heart Examination in the Obese Population

DEGUM, ÖGUM, SGUM and FMF Germany Recommendations for the Implementation of First-Trimester Screening, Detailed Ultrasound, Cell-Free DNA Screening and Diagnostic Procedures

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