Assessing extensive cardiac echography examination for detecting foetal congenital heart defects during early and late gestation: a systematic review and meta-analysis

Abstract

Background Extensive cardiac echography examination (ECEE) can identify cardiac heart defects (CHDs) in utero. However, there is not yet a clear appraisal of ECEE’s performance in detecting foetal CHDs as a function of gestational time. In this study, we assessed the diagnostic efficacy of ECEE in detecting CHDs during early gestation (< 18 weeks) and late gestation (≥ 18 weeks).Methods MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched for ECEE studies that had a prenatal diagnosis later validated by echocardiography, catheterization, surgery, or autopsy and allowed construction of 2 × 2 tables. Pooled sensitivity, specificity, and diagnostic odds ratio of ECEE during early and late gestation were calculated. Summary receiver operating characteristic curves were plotted to obtain area under the curve (AUC) values.Results ECEE in late gestation had a slightly superior sensitivity relative to that in early gestation (0.90 vs 0.86, respectively), while ECEE during both early and late gestation displayed near-perfect specificity (1.00 vs 1.00, respectively). ECEE in late gestation displayed a superior diagnostic odds ratio relative to that in late gestation (3,502.81 vs 1,076.79, respectively). ECEE during both early and late gestation displayed similar overall diagnostic accuracy in terms of AUC (0.9861 vs 0.9783, respectively).Conclusions ECEE performed before the 18-week gestational time point provides nearly equivalent diagnostic accuracy to ECEE performed on or after the 18-week gestational time point. However, ECEE conducted prior to week 11 may not be advisable due to the immature development of foetal heart structures.