First Trimester Fetal Echocardiography

Abstract

Objective: The aims of this study were to assess the feasibility of performing a complete fetal echocardiographic study during the first trimester of pregnancy, to establish the best week to accomplish a complete evaluation, and to find a relationship between the diameters of the cardiac valves and gestational age. Methods: 46 fetuses with normal nuchal translucency and venous duct Doppler velocimetry were submitted to echocardiographic studies by the transvaginal approach between the 11 + 0 and 14 + 6 weeks of gestation. A complete echocardiographic evaluation was defined as an examination in which the three basic planes, four-chamber, longitudinal and short-axis views, were obtained. Results: The rates of complete echocardiography evaluation were 37, 85 and 100% at 11, 12 and 13–14 weeks, respectively. The longitudinal view was the easiest to obtain and the short-axis view was the most difficult one. The diameter of the cardiac valves was compared with the crown-rump length (CRL) and there was no statistically significant difference between either the diameters of the mitral and tricuspid or the aortic and pulmonary valves. A linear growth curve was constructed to demonstrate the diameter correlations. Conclusions: The study demonstrated the feasibility of a complete fetal echocardiographic evaluation by the transvaginal approach during the first trimester of gestation. The rate of a complete evaluation increased along the period and reached100% when the CRL was 64 mm or 13 weeks of gestational age. There was a linear correlation between the cardiac valve diameters and the CRL revealing a relationship between the cardiac and fetal development. The absence of a statistically significant difference between the left and right valve dimensions possibly means that there is no predominance of right or left chambers during this period of evaluation.

Optimal visualization of the fetal four‐chamber and outflow tract views with transabdominal ultrasound in the morbidly obese: Are we there yet?

“…The rate of complete fetal cardiac anatomic evaluation can potentially be improved in morbidly obese women by performing first‐trimester transvaginal fetal echocardiography, because the uterus is a mostly a pelvic organ at this period. In expert hands, this has been shown to be achievable in 100% of fetuses of at least 13 weeks' gestational age . In addition to operator skill and fetal size, the proximity of the vaginal probe to the uterus, mitigating any effect maternal obesity may have, contributed to the level of success observed.…”