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Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations.

ABSTRACT: OBJECTIVES:We investigated the potential for improvement in prenatal detection of congenital heart disease (CHD) by routinely performing detailed fetal echocardiography (FE) in all pregnant women. METHODS:Following routine obstetric sonography, 1445 unselected pregnant women were prospectively subjected to FE at gestational ages between 16 and 24 weeks, or at first visit, if they presented later. Maternal or fetal factors, conventionally known to be associated with risk of CHD, were noted. The prevalence and detection rates of cardiac abnormalities were determined, and confirmation of findings by postnatal follow-up was done to ensure accuracy of FE. Prevalence of CHD was compared in pregnancies with or without conventional risk factors. RESULTS:The overall prevalence of CHD was 8.3 per 1000; only 2 CHD cases belonged to the high maternal risk group, while 10 cases were observed without maternal risk factors. Cardiac malformations were suspected in 14 fetuses during obstetric scan; but, only 5 of them had CHD, remaining 9 had structurally normal hearts. 50% of CHD cases occurred in pregnancies not associate with any (fetal or maternal) risk factor. The sensitivity, and specificity for prenatal CHD detection were 91.7% and 100% respectively. CONCLUSIONS:Our study indicates that a substantial proportion of CHD cases occur in women not having high risk of giving birth to children with CHD. FE is a highly sensitive and specific test with strong predictive values. We recommend that FE should be done in every pregnancy.

SUBMITTER: Bhambhani A

PROVIDER: S-EPMC7670276 | biostudies-literature | 2020 Sep - Oct

REPOSITORIES: biostudies-literature

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Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations.

Bhambhani Anupam A Mathew Amalu A Varunya Mary M Uligada Seema S Kala Prachi P

Indian heart journal 20200813 5

<h4>Objectives</h4>We investigated the potential for improvement in prenatal detection of congenital heart disease (CHD) by routinely performing detailed fetal echocardiography (FE) in all pregnant women.<h4>Methods</h4>Following routine obstetric sonography, 1445 unselected pregnant women were prospectively subjected to FE at gestational ages between 16 and 24 weeks, or at first visit, if they presented later. Maternal or fetal factors, conventionally known to be associated with risk of CHD, we ...[more]

PMID: 33189206

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Project description:Background Maternal anemia is a common nutritional problem during pregnancy. Fetal heart quantification (fetal HQ) technology is used to quantitatively evaluate the size, shape, and contractile function of the fetal heart, which can reflect the development of the fetus in the uterus. Methods We used fetal HQ technology to evaluate the basal-apical length (BAL), the transverse width (TW) and the area (A) of the four chamber view at end-diastole in 77 normal fetuses and 40 fetuses of women with anemia. We analyzed the changes of fetal heart size and measured the global sphericity index (GSI), the fraction area change (FAC), and the global longitudinal strain (GLS). The sphericity index (SI) and the fractional shortening (FS) of 24 segments were analyzed to identify any changes of fetal heart morphology and systolic function. The normal range of Z value was set at −2 to 2. Results Fetal BAL, TW, A, and gestational age (GA) were positively linearly correlated, while GSI, GLS, and FAC had no significant correlation with GA. There was no significant difference in fetal BAL, TW, A, GLS, and FAC between the two groups (P>0.05). There was no significant difference in the FS of the 24 segments of the left and right ventricles between the two groups (P>0.05). There was no significant difference in the SI of the 1-24 segments of the right ventricle between the two groups (P>0.05). The difference in fetal GSI between the two groups was statistically significant (P<0.05). There was no significant difference in SI between the 1–22 segments of the left ventricle between the two groups (P>0.05), but there was a statistically significant difference between the 23–24 segments (P<0.05). Conclusions The fetal HQ analysis technology can quickly and simply quantitatively assess the size, shape, and contractility of the fetal heart. Anemia in pregnant women has no significant effect on fetal heart size and systolic function; it only affects the morphology of the heart, showing that the heart tends to be spherical as a whole and some segments of the apical segment of the left ventricle are abnormal.

Project description:BackgroundThe COVID-19 pandemic has negatively affected physical and mental health worldwide. Pregnant women already exhibit an elevated risk for depression compared to the general public, a pattern expected to be exacerbated by the pandemic. Certain lifestyle factors, including moderate exercise, may help support mental health during pregnancy, but it is unclear how the pandemic may impact these associations across different locations. Here, we test whether: (i) reported exercise routine alterations during the pandemic are associated with depression scores; and, (ii) the likelihood of reporting pandemic-related exercise changes varies between women living in metro areas and those in non-metro areas.MethodsThis cross-sectional study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant women in the United States. Participants were recruited April-June 2020 (n = 1,856). Linear regression analyses assessed whether reported COVID-19-related exercise change was associated with depression score as measured by the Edinburgh Postnatal Depression Survey. Logistic regression analyses tested whether a participant's Rural-Urban Continuum Code classification of "metro" was linked with higher odds of reporting exercise changes compared to a "non-metro" classification.ResultsWomen who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Moreover, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas.ConclusionsThese results suggest that the ability to maintain an exercise routine during the pandemic may help support maternal mental health. It may therefore be prudent for providers to explicitly ask patients how the pandemic has impacted their exercise routines and consider altered exercise routines a potential risk factor for depression. An effort should also be made to recommend exercises that are tailored to individual space restrictions and physical health.

Dataset Information

Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations.

Publications

Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations.

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