The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects

Abstract

Plain language summary Heart problems are common in newborn babies, affecting approximately 5–10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year. In the UK, pregnant women are offered a scan at around 20 weeks to try and spot any heart problems. In most cases there is not a clear reason for the problem, but sometimes other issues, such as genetic conditions, are discovered. In recent years the care given to these babies after they are born has improved their chances of surviving. However, it is recognised that babies born with heart problems have a risk of delays in their learning and development. This may be due to their medical condition, or as a result of surgery and complications after birth. In babies with heart problems, there is a need for more research on ultrasound and magnetic resonance imaging (MRI) to understand how the brain develops and why these babies are more likely to have delays in learning and development. This paper discusses the way ultrasound and MRI are used in assessing the baby's brain. Ultrasound is often used to spot any problems, looking at how the baby's brain develops in pregnancy. Advances in ultrasound technologies have made this easier. MRI is well‐established and safe in pregnancy, and if problems in the brain have been seen on ultrasound, MRI may be used to look at these problems in more detail. While it is not always clear what unusual MRI findings can mean for the baby in the long term, increased understanding may mean parents can be given more information about possible outcomes for the baby and may help to improve the counselling they are offered before their baby's birth.

Differences in the success of prenatal diagnosis of birth defects associated with singleton and multiple pregnancies: an observational study of more than 1.9 million births in Zhejiang Province, eastern China, during 2012–2018

“…In addition, physicians should be more cautious when discussing prenatal diagnoses for women with multiple pregnancies and choose the most accurate non-invasive prenatal screening methods to avoid misdiagnoses. Finally, multiple methods of screening should be used for multiple pregnancies, such as ultrasonography, MRI, and genetic testing, as described for a combination of neurological and cardiac defects 32 to improve the prenatal diagnosis rate for BDs. Of all the BDs diagnosed prenatally, the proportion diagnosed before 28 weeks of gestation was significantly lower in multiple pregnancies than in singleton pregnancies, and the same finding was also made for cleft lip with cleft palate, trisomy 21 syndrome, and congenital malformation of the urinary system.…”

Belimumab use during pregnancy: a summary of birth defects and pregnancy loss from belimumab clinical trials, a pregnancy registry and postmarketing reports

“…Over the past decade, advances in ultrasound technology have enhanced the ability to detect malformations in utero and after birth. [39][40][41] Estimates of pregnancy loss among women with SLE are ~20% (range across 44 studies: 2.9%-52.6%; see online supplemental file 1), with estimates increasing for those with a longer duration of disease. [42][43][44][45] Available data on belimumab use in pregnant women are insufficient to determine whether there are drug-associated risks for birth defects.…”

“…Detailed anatomy ultrasound scans, foetal echocardiography and serial scans are recommended for pregnant individuals with SLE due to increased risks of congenital heart block and foetal growth restriction. Over the past decade, advances in ultrasound technology have enhanced the ability to detect malformations in utero and after birth 39–41. Estimates of pregnancy loss among women with SLE are ~20% (range across 44 studies: 2.9%–52.6%; see online supplemental file 1), with estimates increasing for those with a longer duration of disease 42–45…”

Antenatal Fetal Assessment: 75 Years Later (1945-2019)

“…The major secondary MRI value is in the event of complex fetal anomalies being identified and counselling and an outcome assessment for the fetus(es) being required. 19,20 This limited review does not allow detailed comment for the isolated or multiple fetal anomalies that may be identified. The diagnosis and management of fetal malformations are summarized in Fetal Medicine: Basic Science and Clinical Practice, third edition.…”