Prenatal Detection of Cardiac Anomalies in Fetuses with Single Umbilical Artery: Diagnostic Accuracy Comparison of Maternal-Fetal-Medicine and Pediatric Cardiologist

Ilir Tasha,Rachel Brook,Noam Lazebnik,Heidi Frasure

doi:10.1155/2014/265421

Ilir Tasha, Rachel Brook + Show 2 more

Open Access

https://doi.org/10.1155/2014/265421

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Abstract

Aim. To determine agreement of cardiac anomalies between maternal fetal medicine (MFM) physicians and pediatric cardiologists (PC) in fetuses with single umbilical artery (SUA). Methods. A retrospective review of all fetuses with SUA between 1999 and 2008. Subjects were studied by MFM and PC, delivered at our institution, and had confirmation of SUA and cardiac anomaly by antenatal and neonatal PC follow-up. Subjects were divided into four groups: isolated SUA, SUA and isolated cardiac anomaly, SUA and multiple anomalies without heart anomalies, and SUA and multiple malformations including cardiac anomaly. Results. 39,942 cases were studied between 1999 and 2008. In 376 of 39,942 cases (0.94%), SUA was diagnosed. Only 182 (48.4%) met inclusion criteria. Cardiac anomalies were found in 21% (38/182). Agreement between MFM physicians and PC in all groups combined was 94% (171/182) (95% CI [89.2, 96.8]). MFM physicians overdiagnosed cardiac anomalies in 4.4% (8/182). MFM physicians and PC failed to antenatally diagnose cardiac anomaly in the same two cases. Conclusions. Good agreement was noted between MFM physicians and PC in our institution. Studies performed antenatally by MFM physicians and PC are less likely to uncover the entire spectrum of cardiac abnormalities and thus neonatal follow-up is suggested.

Highlights

A normally formed umbilical cord contains two umbilical arteries and one umbilical vein
A total of 39,942 pregnant women were studied between January 1999 and October 2008 by MFM physicians in the Fetal Imaging Unit at University Hospitals Case Medical Center, Cleveland, Ohio
The contributing reasons for lack of pediatric echocardiography follow-up among patients diagnosed by MFM physicians to have cardiac anomalies were: Complex congenital anomalies resulting in elective termination of pregnancy, spontaneous intrauterine death, patient choice to not pursue follow-up fetal echography and delivery outside our institution

Summary

Introduction

A normally formed umbilical cord contains two umbilical arteries and one umbilical vein. A single umbilical artery (SUA) is the most common anatomical abnormality of the umbilical cord. It is found in 0.08% to 1.90% of all pregnancies [1]. The most effective method for prenatal screening of congenital anomalies is the second trimester detailed ultrasound study. The study is performed by Maternal-Fetal-Medicine (MFM) physicians and radiologists. Ultrasound studies will successfully reveal SUA in most pregnancies. SUAs have been associated with fetal aneuploidy, premature delivery, stillbirths, low birth-weight, and multiple congenital anomalies (including cardiac, renal, and musculoskeletal [4,5,6] structures). Congenital anomalies among fetuses with a SUA have been reported to be as high as 46% [6], with 31% of fetuses with a SUA having a congenital cardiac anomaly [4, 5]

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