Role of Fetal Echocardiograpghy in Screening for Congenital Heart Disease in High Risk Pregnancies

Abstract

Congenital heart disease (CHD) accounts for nearly one-third of all major congenital anomalieswith total prevalence of about 8 per 1000 births (van der Linde et al., 2011; Dolk et al., 2011). The incidence is four to five times more frequent in aborted spontaneously or stillborn and accounts for approximately 20% of neonatal deaths, 50% of infant deaths (Hoffman, 1995 a, b; Hoffman and Kaplan, 2002). The progress in fetal echocardiography during the past two decades has allowed for the prenatal diagnosis of all types of CHD in experienced hands (Germanakis and Sifakis, 2006). Fetal echocardiography is an accurate and safe method for prenatal diagnosis of fetal cardiac anomalies, arrhythmias, understanding the development of fetal cardiac defects and a guide for fetal cardiac interventions (Jone and Schowengerdt, 2009). It can play an important role in elucidating the pathogenesis and hemodynamic effects of noncardiac lesions, such TTTS and AV malformations (Sekar & Hornberger, 2009). Prenatal detection of congenital heart diseases is important for fetal and perinatal management; however, there is little in literature regarding outcome of pharmacologic intervention for fetal CHD in Egypt. Our study aimed at screening for congenital heart disease whether structural, functional or electrical in high risk pregnancies for diagnosis and proper management of the cases. Cases that fulfilled inclusion criteria were diagnosed using detailed fetal Echocardiographic examination and antenatal treatment was described whenever indicated after a written consent. Postnatal echo was done to confirm diagnosis whenever feasible Ninety four fetuses fulfilled inclusion criteria with mean gestational age at diagnosis 27.89 ±4.61 weeks. The mean maternal age at diagnosis was 25.34 ± 3.396 years. Maternal risk factors were present in 90.4% while fetal risk factors were present in 9.65%. The commonest referral indication was maternal diabetes (31.9%) followed by family history of CHD (26.6%). But no cases referred due to other well-known indications like increased nuchal translucency, maternal exposure to teratogens. As regard the relation between fetal risk factors and the outcome we had a sensitivity of 88.89% and specificity of 98.8% especially the cases referred due to accidental discovery by OBS US which had a sensitivity of 100% and specificity of 97.6%.

All fetuses had detailed echocardiographic examinations. Two fetuses died intrauterine. Eighty five cases (90.3%) had normal fetal echocardiography while nine cases were abnormal (9.7%) while on follow up fetal echo sixteen cases were normal (76.2%) and five cases were abnormal (23.8%).