title: Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease.
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.
authors: Department of Medical Education, Icahn School of Medicine, New York, New York.
authors: Jonathan
authors: J
authors: Komisar
authors: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Shubhika
authors: S
authors: Srivastava
authors: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Miwa
authors: M
authors: Geiger
authors: Department of Preventive Medicine, Icahn School of Medicine, New York, New York.
authors: John
authors: J
authors: Doucette
authors: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Helen
authors: H
authors: Ko
authors: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Jay
authors: http://orcid.org/0000-0002-6868-5005
authors: J
authors: Shenoy
authors: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.
authors: Rajesh
authors: R
authors: Shenoy
mesh_terms: D004452:Echocardiography / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D009519:New York City; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends
keywords: congenital heart disease; fetal echocardiography; obesity