First‐trimester ductus venosus screening for cardiac defects: a meta‐analysis

Papatheodorou, Stefania; Εvangelou, Εvangelos; Makrydimas, George; Ioannidis, John P. A.

doi:10.1111/j.1471-0528.2011.03029.x

Cited by 56 publications

(59 citation statements)

References 35 publications

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“…126 In a meta-analysis, euploid fetuses with NT at or above the 95th percentile and abnormal ductus venosus flow had a 15% incidence of major heart malformations. 76 When NT was at or above the ≥99th percentile, the incidence increased to ≈20%. 127 This indicates that the addition of ductus venosus Doppler analysis is useful for identifying those at greatest risk among the high-risk screening population.…”

mentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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mentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

View full text Add to dashboard Cite

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“…During the meta-analysis conducted by Rachel and Rachael (2014), 7 completed studies were included regardless of NT status, 9 studies with increased NT were included and 7 studies with normal NT were included, and the summary revealed that sensitivity of abnormalities for TR and DV flow in the detection of CHDs were 50%, 93%, 83% while the specificity was 19%, 80% and 96% respectively [9].…”

Section: Discussionmentioning

confidence: 99%

Contribution of Fetal Tricuspid Regurgitation in First Trimester Screening for Major Cardiac Defects in Ulaanbaatar

Shirchinjav,

Tovuudorj,

Tudevdorj

2017

Cent. Asian j. Med. Sci.

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Objective: To estimate the potential value of fetal assessment for tricuspid regurgitation, nuchal translucency and ductus venosus at 11-13 weeks of gestation in the prediction of major cardiac defects. Methods: Prospective cohort study data was derived from first-trimester screening of pregnant women at National Center for Maternal and Child Health between March 2014 to May 2017. A total of 318 patients at 110 to 136 weeks of gestation enrolled in the study. Trans abdominal ultrasonography (using 3 to 7.5 MHz curvilinear transducers) was performed to indirectly measure gestational age using the fetal crown-rump length, measure the fetal nuchal translucency thickness, and to assess blood flow across the tricuspid valve in 304 live fetuses in singleton pregnancies. Results: The median age of the mothers was 34 (range, 19-46 years). Crown-rump length of ranged from 45-84 mm. Eight (3.2%) of the 304 fetuses were diagnosed with major heart defects and increased nuchal translucency and tricuspid regurgitation were shown to be strongly associated with CHD. Increased nuchal translucency was present in 83% of fetuses with CHD (p=0.0001), while tricuspid regurgitation was present in 73% of those same fetuses (p=0.012). Conclusion: First trimester fetal ultrasound biomarkers can be sued to screen for major heart defects. Increased NT and TR are important indicators of the need for echocardiography, which is useful for early prenatal diagnosis of CHD.

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“…Waveform analysis of the ductus venosus reduces the false-positive rate of the screening test [139,140]. For example, in fetuses with increased NT but with normal karyotype, from 11 to 13 6/7 weeks, absent or reversed A-wave (atrial contraction) in the ductus venosus is associated with a threefold increase in the likelihood of a major cardiac defect, whereas normal ductal flow is associated with a 50 % reduction in the risk for such defects [141][142][143]. It is clear that Doppler is an important tool to study fetal health in early (and late) pregnancy [130] but appropriate precautions need to be taken to limit exposure in terms of clear indication, time and acoustic output [144].…”

Section: Is Doppler Different and Can It Have Detrimental Effects On mentioning

confidence: 99%

Ultrasound in the First Trimester and Earlier: How to Keep It Safe

Abramowicz

2016

First-Trimester Ultrasound

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1"Ultrasound is safe. Ultrasound is not X-rays. Our machines are FDA-approved." These are the statements most commonly made when initiating a conversation on safety of ultrasound. This is one of the reasons cited for its becoming an essential tool in medicine (together with its relatively low cost and immediate results availability). Diagnostic ultrasound (DUS) has been in use for over half a century in obstetrics and gynecology [1] and the benefits of this technology are multiple [2]. Most pregnant women have 2-3 ultrasound examinations (and many more in certain countries) during their pregnancies. In early pregnancy and before (i.e., in Artificial Reproductive Technologies [(ART]), these include serial scans of the developing follicles during ovulation induction [3] and in the earliest stages of gestation [4], first-trimester ultrasound for viability and/or aneuploidy screening (nuchal translucency, NT) and, more and more, early anatomy survey [5]. Such is the widespread enthusiasm and the generally accepted notion of safety that its use has spilled into the commercial world with mall stores offering non-medical ultrasound or "souvenir" scans. The record of safety of DUS is excellent: there are no epidemiological studies demonstrating harmful effects in human fetuses [6]. Most human epidemiological studies, however, published so far are based on information obtained with pre-1991/1992 machines. Around that time, the US Federal Drug Administration (FDA) allowed the acoustic output of ultrasound machines for fetal use to be increased from 94 to 720 mW/cm 2 , a factor of almost 8 [7,8]. Is there enough evidence to validate the use of ultrasound imaging in general and Doppler in particular in the first trimester [9] and could ultrasound have detrimental effects on the fetus in the first trimester, a time of maximal susceptibility to external factors? If there are clinical indications to perform these scans (and if there were none, there would be no raison-d'être for this book) safety must be guaranteed by educating the end-users on ways to limit the possible hazards of exposure of the follicles/ova and the fetus at early stages of gestation [2].

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First‐trimester ductus venosus screening for cardiac defects: a meta‐analysis

Cited by 56 publications

References 35 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Contribution of Fetal Tricuspid Regurgitation in First Trimester Screening for Major Cardiac Defects in Ulaanbaatar

Ultrasound in the First Trimester and Earlier: How to Keep It Safe

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