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Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease

Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease

Authors :
Komisar, Jonathan
Srivastava, Shubhika
Geiger, Miwa
Doucette, John
Ko, Helen
Shenoy, Jay
Shenoy, Rajesh
Source :
Congenital Heart Disease; January 2017, Vol. 12 Issue: 1 p67-73, 7p
Publication Year :
2017

Abstract

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. 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. 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). 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.

Details

Language :
English
ISSN :
1747079X and 17470803
Volume :
12
Issue :
1
Database :
Supplemental Index
Journal :
Congenital Heart Disease
Publication Type :
Periodical
Accession number :
ejs41244182
Full Text :
https://doi.org/10.1111/chd.12405