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Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease

Jonathan Komisar1, Shubhika Srivastava2, Miwa Geiger2, John Doucette3, Helen Ko2, Jay Shenoy2, Rajesh Shenoy2
1 Department of Medical Education, Icahn School of Medicine, New York, New York
2 Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York
3 Department of Preventive Medicine, Icahn School of Medicine, New York, New York
* Corresponding Author: Rajesh Shenoy, MD, Division of Pediatric Cardiology, Box 1201, Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029-6574. Email:

Congenital Heart Disease 2017, 12(1), 67-73.

Abstract

Background: Antenatal diagnosis of congenital heart defects (CHD) can impact outcomes in neonates with severe CHD. Obstetric screening guidelines and the indications for fetal echocardiography (FE) have evolved in an attempt to improve the early prenatal detection of CHD. Analyzing yield for specific indications will help clinicians better stratify at-risk pregnancies.
Methods: Retrospective cohort study of all FE performed between 2000 and 2010 at a single tertiary care academic medical center in New York City. A total of 9878 FE met inclusion criteria for our study. In cases of multiple gestations (MG), each fetus was counted as a separate study.
Results: The number of new diagnosis of fetal CHD by FEs increased 200%. There was a statistically significant increase in those referred for suspected CHD, increased nuchal translucency (NT), MG, and suboptimal imaging (P < .001). The indication of “suboptimal imaging” (SO) not only accounted for 5.23% of all referrals from 2000 to 2002, compared to 22.26% of all referrals from 2008 to 2010 (P < .0001), but also had the lowest yield for diagnoses of CHD (P< .02).
Conclusions: Over the past decade, there has been an increase in utilization of FE with a proportional increase in prenatally diagnosed CHD. For indications such as suspected CHD, NT and MG increases in referrals have led to a proportionate increase in fetal diagnosis of CHD. SO as an indication has the lowest yield of fetal diagnosis of CHD. Antenatal detection of CHD may be improved by a change in obstetric imaging protocols to ensure appropriate referrals.

Keywords

congenital heart disease, fetal echocardiography, obesity

Cite This Article

Komisar, J., Srivastava, S., Geiger, M., Doucette, J., Ko, H. et al. (2017). Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease. Congenital Heart Disease, 12(1), 67–73.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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