ABSTRACT
Antenatal detection of congenital heart diseases [CHD] is crucial because obstetric and neonatal management is likely to be altered. Aim of this study was to evaluate indications of fetal echocardiography in Mansoura University teaching hospitals, and evaluate its yield and impact on obstetric and neonatal management. Inclusive of 152 fetal echocardiograms were performed in Mansoura pediatric cardiology unit for 120 high risk pregnant women over 33 months duration. Triplex ultrasound machine was used with 3.5 or 5 MHz transabdominal probes. Mean maternal age was 27.51 +/- 4.7 years [range 18-39 years], mean gestational age at referral was 26.8 +/- 5.2 weeks [range 18-39 weeks]. Most common indications for referral were family history of CHD [n=34], extracardiac anomalies [n=26], maternal diabetes [n=20]. Abnormal cardiac findings on antenatal sonographic scanning [n=4] were one of less common referral indications. CHDs were accurately predicted in 16 cases [13.3%], 3 cases had echogenic intracardiac foci [EIF] [2.5%]. Abnormal fetal Doppler velocimetries were detected in 4 cases [3.3%] with structurally normal heart indicating abnormal fetal status, and obstetric decision was altered accordingly. Association with extracardiac anomalies were present in 7cases [43.7%], abnormal karyotype was detected in one case [6.2%] with CHD. Fourteen cases [12.06%] had CHDs out of 116 cases with primary indication for fetal echocardiography and normal antenatal obstetric scan, 2 cases [50%] out of 4 with abnormal cardiac findings on antenatal scan had CHDs. Small muscular ventricular septal defect was detected postnatally in one case with EIF giving sensitivity of 94.4% and specificity of 100%. Four cases with complex CHDs were transferred to pediatric cardiac facility center for appropriate management. Elective termination of pregnancy was offered to 2 cases. Neonatal death occurred in 7 [37.5%] cases with CHD and in two cases [50%] with abnormal Doppler velocimetry. Fetal echocardiography is valuable tool in diagnosis of fetal CHDs in high risk pregnant women with high sensitivity and specificity. Abnormal cardiac findings during prenatal sono graphic scanning are more yielding for identifying CHDs. Fetal Doppler velocimetry is useful in evaluating fetal homodynamic status