Screening of congenital heart disease in the second trimester of pregnancy: current knowledge and new perspectives to the clinical practice.
OBJECTIVE
Congenital heart diseases are common in foetuses, with an incidence greater than six times that of chromosomal abnormalities; however, experts in cardiac anatomy have evaluated only the foetuses of pregnant women with increased risk for congenital heart disease. Over the years, it has become clear that congenital heart disease occur in foetuses of low-risk women. In the mid-1980s, a proposal to expand the assessment of cardiac anatomy was presented to obstetricians in order to improve prenatal screening. With the aim to systematise and improve the diagnosis of congenital heart disease in foetuses, the International Society of Ultrasound in Obstetrics and Gynecology established an ultrasound heart examination guideline. In this review, we have described the important features of this guideline and discussed the applications of this tool in clinical practice.


METHODS
We performed a literature search of the National Library of Medicine for publications released between 2000 and 2012; we used search terms pertinent to congenital heart disease, such as foetal echocardiography, foetal heart and cardiac screening examination.


RESULTS
The guidelines serve as a standard and help to systematise the screening for congenital heart diseases, but we think that some topics may be added to design the most appropriate screening method. However, we cannot expand the topics to be evaluated in this examination without good training of sonographers who undergo this screening.


CONCLUSIONS
Although the screening standardisation is a good tool to be used in day-to-day practice, the increment of aortic and ductal archs and colour Doppler to heart screening could be useful to detect further cardiac defects.
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Luciane
L
Alves Rocha
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Edward
E
Araujo Júnior
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Liliam Cristine
LC
Rolo
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Fernanda Silveira Bello
FS
Barros
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Karina Peres
KP
Silva
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Luis Henrique
LH
Martinez
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Luciano Marcondes Machado
LM
Nardozza
Department of Obstetrics, Fetal Cardiology Unit, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Antonio Fernandes
AF
Moron
D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal