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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Identification of fetal cardiac anatomy and hemodynamics: a novel enhanced screening protocol

Authors: Ying Zhang, Ai-Lu Cai, Wei-dong Ren, Ya-Jun Guo, Dong-yu Zhang, Wei Sun, Yu Wang, Lei Wang, Yue Qin, Li-ping Huang

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Prenatal cardiac screening is of great importance as it contributes to appropriate neonatal management and helps parents to make a decision regarding their pregnancy. The aim of our study was to evaluate the efficiency of a newly proposed screening protocol in the detection of fetal congenital heart disease (CHD).

Methods

This was a prospective study. A total of 52 cases of confirmed CHD fetuses and 248 cases of randomly selected normal fetuses were included in the study. Two sonographers with similar experience performed the cardiac screenings under two different protocols independently. The conventional protocol (Protocol A) paid greater attention to the four-chamber view and the outflow tract views. A 6-month training program was provided to sonographers performing scans under the new protocol (Protocol B), which emphasized systematically evaluating fetal cardiac anatomy and hemodynamics. Color Doppler was mandatory and some ultrasonic signs for special cardiac anomalies were also introduced into this protocol.

Results

Protocol B detected more cardiac anomalies than did Protocol A (96.2 % vs. 61.5 %, P < 0.01). Specifically, Protocol B was superior to Protocol A in detecting cardiac malpositions, abnormal systemic and pulmonary venous connection, right aortic arch, transposition of the great arteries, and congenital corrected transposition of the great arteries. By visualizing flow disturbance and retrograde flow with color Doppler, Protocol B was better than Protocol A in screening valvular associated malformations, such as pulmonary atresia, pulmonary stenosis, tricuspid dysplasia, etc. For the normal fetuses, Protocol B was better than Protocol A in reducing the false-positive detection of septal defects.

Conclusions

The current study introduces an enhanced protocol for fetal cardiac screening, under which the obstetric screening sonographers systematically identify fetal cardiac anatomy and hemodynamics. A short-term training program makes it possible for the screening sonographers to become familiar with the new protocol, and its value has been confirmed due to improvements made in screening efficiency.
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Literature
1.
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890–900.CrossRefPubMed
2.
Massaro AN, El-Dib M, Glass P, Aly H. Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev. 2008;30(7):437–46.CrossRefPubMed
3.
Cuneo BF, Curran LF, Davis N, Elrad H. Trends in prenatal diagnosis of critical cardiac defects in an integrated obstetric and pediatric cardiac imaging center. J Perinatol. 2004;24(11):674–8.CrossRefPubMed
4.
Meberg A, Otterstad JE, Froland G, Lindberg H, Sorland SJ. Outcome of congenital heart defects--a population-based study. Acta Paediatr. 2000;89(11):1344–51.CrossRefPubMed
5.
Gillum RF. Epidemiology of congenital heart disease in the United States. Am Heart J. 1994;127(4 Pt 1):919–27.CrossRefPubMed
6.
7.
8.
Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benfits of a training programme for obstetric ultrasonographers. Heart. 2000;84(3):294–8.CrossRefPubMedPubMedCentral
9.
Sharland G. Routine fetal cardiac screening: what are we doing and what should we do? Prenat Diagn. 2004;24(13):1123–9.CrossRefPubMed
10.
Chew C, Halliday JL, Riley MM, Penny DJ. Population-based study of antenatal detection of congenital heart disease by ultrasound examination. Ultrasound Obstet Gynecol. 2007;29(6):619–24.CrossRefPubMed
11.
Copel JA, Pilu G, Green J, Hobbins JC, Kleinman CS. Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view. Am J Obstet Gynecol. 1987;157(3):648–55.CrossRefPubMed
12.
Allan LD, Crawford DC, Chita SK, Tynan MJ. Prenatal screening for congenital heart disease. Br Med J (Clin Res Ed). 1986;292(6537):1717–9.CrossRef
13.
Oggè G, Gaglioti P, Maccanti S, Faggiano F, Todros T. Prenatal screening for congenital heart disease with four chamber and outflow-tract views: a multicenter study. Ultrasound Obstet Gynecol. 2006;28(6):779–84.CrossRefPubMed
14.
Chaoui R. The four-chamber view: four reasons why it seems to fail in screening for cardiac abnormalities and suggestions to improve detection rate. Ultrasound Obstet Gynecol. 2003;22(1):3–10.CrossRefPubMed
15.
Sklansky MS, Berman DP, Pruetz JD, Chang RK. Prenatal screening for major congenital heart disease: superiority of outflow tracts over the 4-chamber view. J Ultrasound Med. 2009;28(7):889–99.CrossRefPubMed
16.
Carvalho JS, Allan LD, Chaoui R, Copel JA, DeVore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG practice guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol. 2013;41(3):348–59.CrossRefPubMed
17.
Zhang Y, Fan M, Ren WD, Xie LM, Ding CW, Sun W, Wang Y, Guo YJ, Cai AL. Prenatal diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition. BMC Pregnancy Childbirth. 2013;13:79.CrossRefPubMedPubMedCentral
18.
Jeanty P, Chaoui R, Tihonenko I, Grochal F. A review of findings in fetal cardiac section drawings, part 1: The 4-chamber view. J Ultrasound Med. 2007;26(11):1601–10.CrossRefPubMed
19.
Jeanty P, Chaoui R, Grochal F, Tihonenko I. A review of findings in fetal cardiac section drawings, part 2: high abdominal views. J Ultrasound Med. 2007;26(12):1743–6.CrossRefPubMed
20.
Jeanty P, Chaoui R, Tihonenko I, Grochal F. A review of findings in fetal cardiac section drawings, part 3: the 3-vessel-trachea view and variants. J Ultrasound Med. 2008;27(1):109–17.CrossRefPubMed
21.
Jeanty P, Chaoui R, Grochal F. A review of findings in fetal cardiac section drawings, part 4: sagittal and parasagittal views. J Ultrasound Med. 2008;27(6):919–23.CrossRefPubMed
22.
Mapp T. Fetal echocardiography and congenital heart disease. Prof Care Mother Child. 2000;10(1):9–11.PubMed
23.
Ott WJ. The accuracy of antenatal fetal echocardiography screening in high- and low-risk patients. Am J Obstet Gynecol. 1995;172(6):1741–7. discussed 1747-9.CrossRefPubMed
24.
Copel JA, Pilu G, Kleinman CS. Congenital heart disease and extracardiac anomalies: associations and indications for fetal echocardiography. Am J Obstet Gynecol. 1986;154(5):1121–32.CrossRefPubMed
25.
Buskens E, Stewart PA, Hess J, Grobbee DE, Wladimiroff W. Efficacy of fetal echocardiography and yield by risk category. Obstet Gynecol. 1996;87(3):423–8.CrossRefPubMed
26.
Sharland GK, Allan LD. Screening for congenital heart disease prenatally. Results of a 2 1/2-year study in the South East Thames Region. Br J Obstet Gynaecol. 1992;99(3):220–5.CrossRefPubMed
27.
Tegnander E, Eik-Nes SH, Johansen OJ, Linker DT. Prenatal detection of heart defects at the routine fetal examination at 18 weeks in a no-selected population. Ultrasound Obstet Gynecol. 1995;5(6):372–80.CrossRefPubMed
28.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med. 2011;30(1):127–36.CrossRef
29.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med. 2013;32(6):1067–82.CrossRef
Metadata
Title
Identification of fetal cardiac anatomy and hemodynamics: a novel enhanced screening protocol
Authors
Ying Zhang
Ai-Lu Cai
Wei-dong Ren
Ya-Jun Guo
Dong-yu Zhang
Wei Sun
Yu Wang
Lei Wang
Yue Qin
Li-ping Huang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-0933-9

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