Indian heart journal · 2026
Diagnostic value of fetal echocardiography in detecting congenital heart disease.
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Viegas Michelle, Naik Guruprasad D, Narvekar Sapna, Lotliker Rajvi D, George Lerin
Аннотация
OBJECTIVES: To determine the sensitivity and specificity of fetal echo (FE) and predictive risk factors for congenital heart disease (CHD) in high-risk pregnancies.
METHODS: 970 consecutive high-risk pregnancies referred for FE were studied. All patients were followed up with a neonatal echo. Risk factors in the mother were correlated with CHD in the fetus. The sensitivity and specificity of fetal echo for CHD were compared with the neonatal echo.
RESULTS: 1010 fetuses were evaluated. A follow-up of the fetal echo was obtained in 904 (89.5%) patients. Risk factors for referral for fetal echocardiography included maternal diabetes (n = 454, 45%), echogenic foci (n = 93, 9.2%), cardiac anomaly on ultrasound (n = 90, 8.9%), and IVF pregnancies (n = 52, 5.1%). 0.4% had arrhythmias. 89 patients had CHD. VSD was the commonest CHD (15 patients), followed by single ventricle (11) and TOF (10). GDM did not correlate with CHD. None of the IVF pregnancies had CHD. Only ultrasound showing cardiac anomaly correlated with CHD (p < 0.001), but 25% of cases were missed. Fetal echo had a very high sensitivity of 95.5% and specificity of 99.5% for detecting CHD, with slightly reduced sensitivity of 94.3% after 28 weeks. The commonly missed anomalies were small VSDs and anomalies of venous drainage. The fetal mortality with CHD was significantly higher at 38.6% versus 4.5% with no CHD.
CONCLUSION: Fetal echo has a very high sensitivity of 95.5% and specificity of 99.5% in detecting CHD. There was a high incidence of CHD in high-risk pregnancies, 88/1000. The most common CHD was VSD. Small VSDs and anomalies of venous drainage were the most frequently missed anomalies. In this study, GDM did not correlate with CHD. Ultrasound showing cardiac anomaly was the only predictor of CHD; hence, in India, where there is a shortage of healthcare resources, training radiologists to include outflow tract views and performing fetal echo in all high-risk pregnancies would result in optimal utilization of resources.
METHODS: 970 consecutive high-risk pregnancies referred for FE were studied. All patients were followed up with a neonatal echo. Risk factors in the mother were correlated with CHD in the fetus. The sensitivity and specificity of fetal echo for CHD were compared with the neonatal echo.
RESULTS: 1010 fetuses were evaluated. A follow-up of the fetal echo was obtained in 904 (89.5%) patients. Risk factors for referral for fetal echocardiography included maternal diabetes (n = 454, 45%), echogenic foci (n = 93, 9.2%), cardiac anomaly on ultrasound (n = 90, 8.9%), and IVF pregnancies (n = 52, 5.1%). 0.4% had arrhythmias. 89 patients had CHD. VSD was the commonest CHD (15 patients), followed by single ventricle (11) and TOF (10). GDM did not correlate with CHD. None of the IVF pregnancies had CHD. Only ultrasound showing cardiac anomaly correlated with CHD (p < 0.001), but 25% of cases were missed. Fetal echo had a very high sensitivity of 95.5% and specificity of 99.5% for detecting CHD, with slightly reduced sensitivity of 94.3% after 28 weeks. The commonly missed anomalies were small VSDs and anomalies of venous drainage. The fetal mortality with CHD was significantly higher at 38.6% versus 4.5% with no CHD.
CONCLUSION: Fetal echo has a very high sensitivity of 95.5% and specificity of 99.5% in detecting CHD. There was a high incidence of CHD in high-risk pregnancies, 88/1000. The most common CHD was VSD. Small VSDs and anomalies of venous drainage were the most frequently missed anomalies. In this study, GDM did not correlate with CHD. Ultrasound showing cardiac anomaly was the only predictor of CHD; hence, in India, where there is a shortage of healthcare resources, training radiologists to include outflow tract views and performing fetal echo in all high-risk pregnancies would result in optimal utilization of resources.