Abstract
Congenital heart diseases (CHDs) are one of the most common fetal malformations; the aim of the present study was to assess the role of fetal echocardiography in diagnosis of CHDs. The prenatal diagnosis of CHDs has been shown to have a significant effect on prenatal and postnatal management and outcomes. The current prospective study included 80pregnant women; detailed fetal echocardiography was performed according to International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines [1]. In this study the range of gestational age was between 20 – 35 weeks, (57.5%) were males and (42.5%) were females, 48 CHDs (60%) were detected in the low risk group and 32 (40%) were found in the high risk group, we found the most frequent risk factors for CHDs was positive parental consanguinity in (18 cases), multiple risk factors were found in (14 cases), there was insignificant correlation between mother age, fetal age and presence of risk factors. Our results showed that 20% of cases had associated ECAs, while 80% of cases had no associated ECAs. The most frequent CHDs encountered in our study was isolated VSDs (10%). Complete agreement was found in (85%) of cases between prenatal and postnatal echo findings. It is concluded that due to the high frequency of CHDs within the low risk pregnant females, we suggest that basic fetal echocardiography should be done for all pregnant women regardless the presence of risk factors.
Highlights
IntroductionFetal echocardiography is defined as a detailed sonographic evaluation that is used to identify and characterize fetal cardiac anomalies prenatally; it has evolved considerably over the past 1-2 decades into an exciting field that bridges maternal-fetal medicine with neonatology and pediatric cardiology [2].Congenital heart diseases (CHDs) are the most common fetal malformations with incidence of four to eight cases per 1,000 live births being responsible for 20% of neonatal mortality and 50% of the deaths in infants [3].Prenatal diagnosis of CHDs has been shown to have a significant effect on prenatal and postnatal management and outcomes, it lead to additional testing of the fetus, including genetic evaluation and other anatomic imaging, which can yield valuable information in overall assessment of the fetus, which allows families to make informed decisions regarding the pregnancy and to prepare emotionally for the birth of a child with significant CHDs [4].There are a number of indications for fetal echocardiography which may be maternal, fetal or familial, the maternal indications include gestational diabetes mellitus (DM), connective tissue diseases, such as Sjogren’s syndrome and systemic lupus erythromatosus (SLE), assisted reproductive technology and use of drugs as antipsychotics and anti-epileptics drugs, the fetal indications are thickened nuchal translucency, other structural fetal anomalies, fetal infection [5], Familial indications include history of cardiac structural abnormalities of the parents’ heart, history of cardiac anomalies in previous children and parentalInternational Journal of Medical Imaging 2020; 8(4): 72-83 consanguinity [6]
In the present study 80 pregnant patients were included, the maternal age ranged from 18 to 39 years with the mean of age was 26.80±5.70 years, 42.5% of cases ranged between 18-25 years, 37.5%of cases ranged between 25-35 years
The frequency of Congenital heart diseases (CHDs) increases in multigravida more than primigravida, as we found that (67.5%) 54 out of 80 cases were multigravida while (32.5%) 26 out of 80 cases were primigravida, This is in agreement with Perriyanayaki et al, 2016 [11] who found that the majority of cardiac anomalies were observed in multiparous women when compared with primigravida
Summary
Fetal echocardiography is defined as a detailed sonographic evaluation that is used to identify and characterize fetal cardiac anomalies prenatally; it has evolved considerably over the past 1-2 decades into an exciting field that bridges maternal-fetal medicine with neonatology and pediatric cardiology [2].CHDs are the most common fetal malformations with incidence of four to eight cases per 1,000 live births being responsible for 20% of neonatal mortality and 50% of the deaths in infants [3].Prenatal diagnosis of CHDs has been shown to have a significant effect on prenatal and postnatal management and outcomes, it lead to additional testing of the fetus, including genetic evaluation and other anatomic imaging, which can yield valuable information in overall assessment of the fetus, which allows families to make informed decisions regarding the pregnancy and to prepare emotionally for the birth of a child with significant CHDs [4].There are a number of indications for fetal echocardiography which may be maternal, fetal or familial, the maternal indications include gestational diabetes mellitus (DM), connective tissue diseases, such as Sjogren’s syndrome and systemic lupus erythromatosus (SLE), assisted reproductive technology and use of drugs as antipsychotics and anti-epileptics drugs, the fetal indications are thickened nuchal translucency, other structural fetal anomalies, fetal infection [5], Familial indications include history of cardiac structural abnormalities of the parents’ heart, history of cardiac anomalies in previous children and parentalInternational Journal of Medical Imaging 2020; 8(4): 72-83 consanguinity [6]. Prenatal diagnosis of CHDs has been shown to have a significant effect on prenatal and postnatal management and outcomes, it lead to additional testing of the fetus, including genetic evaluation and other anatomic imaging, which can yield valuable information in overall assessment of the fetus, which allows families to make informed decisions regarding the pregnancy and to prepare emotionally for the birth of a child with significant CHDs [4]. Prenatal detection accuracy has varied widely for CHDs, some of this variation can be attributed to examiner experience, maternal obesity, transducer frequency, abdominal scars, gestational age, amniotic fluid volume, and fetal position [7].
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