title: Factors affecting the feasibility of routine first-trimester fetal echocardiography.
abstract: OBJECTIVE
  The purpose of our study was to assess the factors that may improve the feasibility of routine fetal echocardiography at the time of the first-trimester scan.
  
  
  METHODS
  In this prospective study, we included 616 healthy singleton fetuses. Examinations were performed transabdominally by a single sonographer at the beginning of his training in first-trimester screening. The fetal heart was examined by high-definition color Doppler imaging to obtain the 4-chamber view, right and left ventricular outflow tracts, and 3-vessel and trachea view. Logistic regression was used to investigate the effect on the ability to visualize different cardiac structures.
  
  
  RESULTS
  The frequency of successful heart examinations increased significantly with the number of scans performed (P < .05). The sonographer needed 180 examinations before he could successfully examine the heart in at least 80% of cases. Significant factors that increased the probability of adequate echocardiography were the length of the heart examination and the experience of the sonographer (P< .05) but not transducer-heart distance, maternal body mass index, fetal crown-rump length, placenta interposition, or restrictive fetal position. Visualization of the left ventricular outflow tract could be improved by increasing the experience of the sonographer and decreasing the transducer-heart distance. Also, visualization of the 3-vessel and trachea view depended on the length of the heart examination, the experience of the sonographer, an anterior position of the placenta, and a restrictive fetal position.
  
  
  CONCLUSIONS
  Competence in color flow mapping assessment of the fetal heart at gestational ages of 11 weeks to 13 weeks 6 days is achieved only after extensive supervised training.
authors.affiliation: From the Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania. dragos.nemescu@umfiasi.ro.
authors.forename: Dragos
authors.initials: D
authors.lastname: Nemescu
authors.affiliation: From the Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Onofriescu
mesh_terms: D000293:Adolescent; D000328:Adult; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: feasibility; fetal echocardiography; first trimester; learning curve; obstetric ultrasound