title: Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study.
abstract: BACKGROUND
  The objective of our study was to evaluate the performance of detailed fetal echocardiography by skilled obstetric physician sonologists in the diagnosis of congenital heart disease (CHD) in a Chinese population.
  
  
  METHODS
  This investigation included a multicenter prospective cohort of 10 259 pregnant women attending 10 regional tertiary hospitals in China. The inclusion criteria were singleton pregnancy and gestational age from 18 to ≤28 weeks. Women with multiple pregnancies were excluded. A detailed fetal echocardiography was performed by trained physicians with at least 3 years of experience. The primary outcome measures included sensitivity, specificity, and positive and negative likelihood ratios of detailed fetal echocardiography in prenatal detection of CHD.
  
  
  RESULTS
  The sensitivity and specificity of fetal echocardiography in detecting any CHD were 33.9 and 99.8%, respectively, in the low-risk population, and 68.8 and 99.4%, respectively, in the high-risk population. For detecting major CHDs, fetal echocardiography had a high sensitivity and specificity, and satisfactory positive and negative likelihood ratios in both the low-risk population (88.2, 100%, 6947.7, and 0.118, respectively) and high-risk population (100, 99.9%, 833.3, and <0.0001, respectively). The sensitivity and likelihood ratios were substantially lower for detecting minor CHDs in both populations.
  
  
  CONCLUSIONS
  Detailed fetal echocardiography performed by skilled physicians had high detection rate for major CHD in both low-risk and high-risk populations. However, its value for detecting minor CHD was limited. The incorporation of fetal echocardiography with multiple cardiac views into routine ultrasound screening may improve the detection rate of fetal major CHD and facilitate appropriate parental counseling.
authors.affiliation: Heart Center, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chu
authors.affiliation: Ultrasound Department, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Yingliu
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Ultrasound Department, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Xiaotian
authors.identifier: http://orcid.org/0000-0002-9131-304X
authors.initials: X
authors.lastname: Li
authors.affiliation: Heart Center, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Gui
mesh_terms: D000328:Adult; D002681:China; D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D000068101:Maternal-Child Health Services; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies
keywords: Prenatal diagnosis; termination of pregnancy; training; ultrasound; women's health issues in developing countries