AN OBSERVATIONAL STUDY ANALYZING THE TREND OF CARDIOLOGIST DRIVEN FETAL ECHOCARDIOGRAPHY IN INDIAN SCENARIO WITH A COMPARISON OF PRENATAL VERSUS POSTNATAL FINDINGS: LESSONS LEARNED DURING A LONGITUDINAL ASSESSMENT OF FETAL CARDIA.

Abstract

Background and aims: Fetal echocardiography stands as the diagnostic pivot for serial assessment of cardiovascular anatomy and hemodynamics of fetus from rst trimester to postnatal life. It offers high sensitivity in accurate detection of cardiac development and lesions during intrauterine life. The gold standard remains as postnatal or autopsy validation of antenatal ndings. Our objective was data analysis of the factors determining referral pattern to pediatric cardiologist, conrmation of the diagnosis and appropriateness of parental counseling and pregnancy management strategies. an observational study retrospectively reviewed all pregnant women reporting for fetal e Methods and results: chocardiography to tertiary pediatric cardiac center from February 2021 to July 2023. Relevant factors for referral to pediatric cardiology were tabulated. Fetal echocardiography protocol was adapted from American Institute of Ultrasound in Medicine guidelines with Extended Cardiac Echocardiographic Examination protocol. Fetal echocardiographic results were categorized into simple, severe and functional defects. The fetuses were reviewed postnatally by neonatal echocardiography. Total of 330 pregnant ladies reported for fetal echocardiography in our department, 268 (81.2%) of them were referred cases. The most common reasons for referral were intra-cardiac echogenic foci (ICEF) in 87 (32.5%) cases followed by suspected congenital heart disease (CHD) in 80 (29.9%), maternal illness in 39(14.6%), extra-cardiac anomaly 22 (8.2%), family history of CHD 18(6.7%), fetal arrhythmia 11(4.1%), isolated valve regurgitation seven (2.6%), assisted reproduction three (1.1%) and cardiac mass in one (0.3%) case. We detected cardiac abnormality in 113 (34.2%) fetuses. Of those, 55 (48.7%) had severe CHD, 32 (28.3%) had simple defect and 26(23%) had functional heart defect. 70 (62%) were born with congenital heart disease; of which 15(21.4%) were operated at the appropriate postnatal age. Conclusions: fetal echocardiography by pediatric cardiologist delivers additive diagnostic value and facilitates appropriate parental counseling from mid gestation, helps in proper perinatal triaging and continued cardiac care from fetus- to newborn.