Screening for congenital heart disease with the four-chamber view of the fetal heart.
OBJECTIVE
Our objective was to determine the efficacy of the four-chamber view of the fetal heart in routine ultrasonographic examination as a screening tool for congenital heart defects.


METHODS
A prospective cohort study compared the detection rate of congenital heart defects among 5336 pregnant women screened with the ultrasonographic four-chamber view of the fetal heart from 1987 through 1989 with that among 3680 patients examined ultrasonographically without the four-chamber view during the 2 preceding years (1985 through 1986). All patients were followed until delivery or termination of pregnancy, and clinical or autopsy confirmation of prenatal findings were obtained on all cases.


RESULTS
The overall incidence of congenital heart diseases was 5.2 per 1000 (47/9016). During the years 1985 through 1986 15 neonates with congenital heart diseases were identified, seven of which were prenatally diagnosed (sensitivity 43%). During the period 1987 through 1989 a four-chamber view of the fetal heart was obtained in 95% of cases; 32 cases of congenital heart disease occurred, 26 of which were diagnosed antenatally (sensitivity 81%; p = 0.01). Two false-positive diagnoses were made during the second time period, giving a specificity of 99.9%.


CONCLUSIONS
The four-chamber view of the fetal heart is easily obtained, does not significantly increase the duration of a routine ultrasonographic examination, and has an excellent sensitivity for the identification of congenital heart diseases.
Vergani
P
P
Department of Obstetrics and Gynecology, Istituto di Scienze Biomediche Ospedale S. Gerardo, Monza, Italy.
Mariani
S
S
Ghidini
A
A
Schiavina
R
R
Cavallone
M
M
Locatelli
A
A
Strobelt
N
N
Cerruti
P
P
D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal