title: Early fetal echocardiography: Experience of a tertiary diagnostic service.
abstract: BACKGROUND
  There is a growing body of evidence that most of the major cardiac abnormalities can be diagnosed at 14-15 weeks of gestation. We present our experience of early fetal echocardiography.
  
  
  METHODS
  This is a retrospective cohort study of women referred for early fetal echocardiography at 13-16 weeks of gestation at Royal Prince Alfred Hospital and Sydney Ultrasound for Women between August 2011 and March 2014. Findings of early fetal echocardiography, details of subsequent ultrasound examinations and pregnancy outcome were recorded.
  
  
  RESULTS
  Early fetal echocardiography was performed in 400 euploid fetuses at a mean gestational age of 15(+2)  weeks. 85% of women were referred for increased nuchal translucency. 383/400 (96%) women had both normal early and late fetal echocardiograms 15/400 (3.7%) were found to have a cardiac defect at early fetal echocardiography, including 14 major and one minor abnormality. Two additional minor cardiac defects were diagnosed at later antenatal ultrasounds. One case, defined as being normal antenatally, was found to have a minor cardiac abnormality post-natally. Eight (57%) women whose fetus had a major cardiac defect chose to terminate the pregnancy. In the pregnancies that continued, the sensitivity and specificity for major cardiac defects was 100%, 95% CI (0.98-1.00).
  
  
  CONCLUSIONS
  Early fetal echocardiography is feasible and highly sensitive and specific in experienced hands. The high specificity facilitates early reassurance of those women assessed at increased risk for fetal cardiac malformations.
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.|Sydney Ultrasound for Women, Sydney, New South Wales, Australia.
authors.forename: Ritu
authors.initials: R
authors.lastname: Mogra
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Rahmah
authors.initials: R
authors.lastname: Saaid
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Sydney Ultrasound for Women, Sydney, New South Wales, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Kesby
authors.affiliation: Sydney Ultrasound for Women, Sydney, New South Wales, Australia.
authors.forename: Janette
authors.initials: J
authors.lastname: Hayward
authors.affiliation: Sydney Ultrasound for Women, Sydney, New South Wales, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Malkoun
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Hyett
mesh_terms: D000025:Abortion, Eugenic; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D048208:Nuchal Translucency Measurement; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D016216:Ultrasonography, Prenatal
keywords: congenital heart disease; echocardiography; fetus; prenatal diagnosis; ultrasound