AUTOMATED FETAL HEART ECHOCARDIOGRAPHY BY FIVE-DIMENSIONAL ULTRASOUND IN THE SECOND TRIMESTER OF PREGNANCY (A PILOT STUDY)

Abstract

SUMMARY C ongenital heart diseases (CHDs) are the most common fetal congenital malformations, having a rate 6 times greater than chromosomal aberrations and 4 times greater than neural tube defects (Carvalho, 2002). Third of these anomalies are found at birth, the incidence of congenital heart disease is estimated to be 8-12 in 1000 live births (Barboza et al., 2002). 20% of neonatal deaths and 50% of infant deaths due to malformations are due to cardiac anomalies, Therefore diagnosis of cardiac diseases must not be missed in antenatal period (Panchal and Garg, 2014). Ultrasound fetal echocardiography is the gold standard tool for screening of CHD in the population. Five-Dimensional Ultrasound Fetal echo (FINE), a new technique that automatically archives, reconstruct images, and obtain the nine views of the fetal heart. Furthermore, 3D-ultrasound provides the ability to store volume data that can be manipulated after the patient had left the examination room and also be transmitted electronically to evaluate elsewhere. Despite these advances of 3D-ultrasound, the manipulation of volume data requires a learning curve and is also operator dependent. Automated 3D imaging will allow an operator independent and standardized approach to evaluate complex anatomical evaluation and improve the efficiency by reducing the time to complete the ultrasound examination. Buoyed by the recent advancements in ultrasound technology, numerous studies have been conducted to develop a more efficient and precise automated ultrasound system for biometry (Hur et al., 2015). The aim of this study is to evaluate the accuracy of Five-Dimensional Ultrasound in automated obtaining the nine views of the fetal heart at the second trimester of pregnancy. The study was carried out at the fetal care unit at Ain Shams University Maternity Hospital, Ninety pregnant women were recruited from the fetal care unit who fulfilled the inclusion criteria. They were counseled and after consenting were included in the study. All women were subjected to examination by Two-Dimensional Ultrasound and Five-Dimensional Ultrasound. This study was conducted on 90 pregnant women with a mean age of 25 ± 5 (range, 18 – 36), while mean gestational age by dates of 24 ± 3 (range, 20 – 28). In this study, fetal heart assessment using 5D US fetal echo showed non-significant difference (P>0.05) with conventional 2D US. In this study, Numerical variables were presented as mean ± SD and categorical variables as number and percentage. Paired numerical data were compared using the paired-samples t test. The McNemar exact test was used to compare paired categorical variables. Inter-method agreement for the rating of the quality of cardiac views by 2D US or 5D US was assessed by calculation of the prevalence-adjusted and bias-adjusted kappa coefficient (PABAK). In this study, the overall inter-method agreement between 2D US and 5D US was 0.92, The difference in % of satisfactory views between 2D and 5D US was 1.73%, 95% CI from 0.5% to 3.33%, and P-value was 0.144.