Accuracy of obstetric ultrasonography compared to fetal echocardiography in diagnosis of congenital heart disease at a secondary level hospital in Brazil: A pilot study

Abstract

BackgroundCongenital heart diseases (CHD) are dynamic defects that originate in the embryo, evolving during gestation, and undergoing significant change throughout the entire course of extrauterine life. CHD represent a complex group of abnormalities related to high infant morbidity and mortality. Ultrasonography advances in Obstetrics and Fetal Medicine have contributed to the increased detection of these anomalies, with high screening potential during pregnancy. Despite studies pointing to high fetal echocardiography's sensitivity and specificity, this method is not homogeneously available worldwide yet, particularly in low and medium-income countries. ObjectivesHere we compared the accuracy of obstetric ultrasonography performed between 18 and 22 weeks of gestational age with Fetal Echocardiography. MethodsWe evaluated 44 pregnant women who underwent fetal echocardiography examination. This way, we can comprehend if the first method alone can diagnose fetal cardiac abnormalities or track those that need additional imaging by fetal echocardiography. ResultsIn our sample, Obstetric Ultrasonography reached 81.8% accuracy, 57.1% sensitivity, and 93.3% specificity, whereas Fetal Echocardiography's accuracy was estimated at 97.7%, 100% sensitivity, and 96.8% specificity. ConclusionsDespite the superior accuracy of Fetal Echocardiography, we believe that Obstetric Ultrasonography is enough to establish a probable diagnostic hypothesis when performed by experienced professionals, following the specific guidelines. This way, appropriate referral to tertiary centers can facilitate the care of these infants with complex heart disease that requires aggressive surgical intervention and Neonatal and Cardiac Intensive Care services.