title: Evaluating the Performance of Ultrasound Screening for Congenital Heart Disease: A Descriptive Cohort Study.
abstract: ObjectiveThe objective of this study was to evaluate the rate of abnormal fetal echocardiogram after normal detailed anatomy ultrasound when both are performed by maternal-fetal medicine specialists.Study DesignRetrospective review of women who underwent detailed anatomy ultrasound and fetal echocardiography between 16 and 26 weeks' gestation at a single center. Women included had at least one indication for fetal echocardiography as recommended by the American Institute of Ultrasound in Medicine and normal cardiac anatomy on initial detailed anatomy ultrasound. Women with previous abnormal ultrasound, extracardiac anomalies, and abnormal or incomplete cardiac anatomy on initial examinations were excluded. The primary outcome was abnormal fetal echocardiogram, defined as a structural cardiac anomaly.ResultsA total of 1,000 women (1,052 fetuses) were included. The most common indication for echocardiography was family history of congenital heart disease. Five fetuses had an abnormal echocardiogram (0.5%, 95% confidence interval: 0.2-1.1%), only one of which altered care. The other four were suspected ventricular septal defects; of these, three were not seen on postnatal cardiac imaging.ConclusionThe rate of abnormal fetal echocardiogram after a normal detailed anatomy ultrasound interpreted by maternal-fetal medicine specialists is low. Fetal echocardiography as a second screening test is of low clinical utility and unlikely to be cost-effective in this setting.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Froehlich
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.|Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal-Fetal Care Center, Florida Hospital Medical Group, Maitland, Florida.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Maggio
authors.affiliation: Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Phinnara
authors.initials: P
authors.lastname: Has
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
mesh_terms: D000328:Adult; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D016216:Ultrasonography, Prenatal