Abstract
Aim
To study the trend in referral patterns for fetal echocardiography (FE) and the outcome
Methods
Retrospective study of fetuses referred to a single fetal imaging center for FE from Jan 2008 to Dec 2017. The study group was divided into group 1 (2008–2012) and group 2 (2013–2017). Indications were categorized into ‘low-risk’, ‘maternal-risk’ and ‘fetal-risk’. Detection of cardiac defect (CHD) was noted as abnormal outcome and it was analysed in relation to the referral indication.
Results
The study group had 32,679 cases, 11,468 in group 1 and 21,211 in group 2. Total number of referrals showed an increase of 84% between first and second half of study. ‘Low-risk’ referrals were the most common in both groups but high risk referrals had shown an increase of 24.5% over years. Maternal diabetes was the most common ‘maternal-risk’ factor and abnormal cardiac finding in obstetric scan was the common ‘fetal-risk’ indication. Incidence of CHD increased from 4.6 to 10.2% during the study period. CHD was seen more in ‘fetal-risk’ indications (65%) compared to other risk groups (p < 0.05). Maternal-risk indications individually did not show a significant relationship to CHD. Abnormal cardiac findings in scan, extra-cardiac anomaly, aneuploidy screen positivity, single umbilical artery, growth and liquor abnormality showed a higher risk for CHD. Among low-risk 22.5% showed CHD.
Conclusion
Referral of high-risk cases for FE has increased recently. Abnormal fetal findings in scan or screening tests was significantly associated with fetal CHD. A significant percentage of CHD was detected in the low-risk group. Strengthening fetal cardiac screening is needed to optimise appropriate risk stratification as well as to increase detection of cardiac anomalies.
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References
Bernier PL, Stefanescu A, Samoukovic G, Tchervenkov CI. The challenge of congenital heart disease worldwide: epidemiologic and demographic facts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010;13:26–34.
Moons P, Sluysmans T, De Wolf D, et al. Congenital heart disease in 111225 births in Belgium:birth prevalence, treatment and survival in the 21st century. Acta paediatr. 2009;98:472–54747.
Nair A, Radhakrishnan S. Evaluation of referral pattern for fetal echocardiography at a tertiary care centre in northern india and its implications. J Obstetr Gynecol India. 2016;66(S1):S258–S262262.
Kanwal A, Sheikh AM, Saher T. Determining the factors causing delayed referral for fetal echocardiography at a tertiary care hospital. J Saudi Heart Assoc. 2018;30:205–10.
Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart. 2000;84(3):294–8.
Starikov R, Bohrer J, Goh W, Kuwahara M, Chien EK, Lopes V, et al. Hemoglobin A1c in pregestational diabetic gravidas and the risk of congenital heart disease in the fetus. Pediatr Cardiol. 2013;34(7):1716–22. https://doi.org/10.1007/s00246-013-0704-6.
Hunter LE, Sharland GK. Maternal gestational diabetes and fetal congenital heart disease: an observational study. J Preg Child Health. 2015;2:132. https://doi.org/10.4172/2376-127X.1000132.
Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, on behalf of the American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129:2183–242.
Callan NA, Maggio M, Steger S, Kan JS. Fetal echocardiography: indications for referral, prenatal diagnoses, and outcomes. Am J Perinatol. 1991;8(6):390–4.
Li M, Wang W, Yang X, Yan Y, Wu Q. Evaluation of referral indications for fetal echocardiography in Beijing. J Ultrasound Med. 2008;27(9):1291–6.
Wright L, Stauffer N, Samai C, Oster M. Who should be referred? An evaluation of referral indications for fetal echocardiography in the detection of structural congenital heart disease. Pediatr Cardiol. 2014;35(6):928–33. https://doi.org/10.1007/s00246-014-0877-7.
Prefumo F, Guven MA, Carvalho JS. Single umbilical artery and congenital heart disease in selected and unselected populations. Ultrasound Obstet Gynecol. 2010;35:552–5.
Acknowledgements
We would like to acknowledge the contributions of Dr. Bharathi Das for her contribution towards initial data collection and Mrs. V. Jayanthi for the statistical help provided.
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Thulasi Ammal, M., Chidambarathanu, S., Suresh, I. et al. Referral Pattern for Fetal Echocardiography Over 10 Years in a Single Fetal Imaging Centre from Southern India. J. Fetal Med. 7, 133–138 (2020). https://doi.org/10.1007/s40556-020-00250-x
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DOI: https://doi.org/10.1007/s40556-020-00250-x