Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2025
Embedding Fetal Cardiologists in Maternal-Fetal-Medicine Clinics and Near Universal State-Wide Detection of Critical Cardiovascular Malformations: The Nevada Experience.
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Evans William N, Acherman Ruben J, Kip Katrinka T, Luna Carlos F, Ludwick Joseph M, Rollins Robert C, Castillo William J, Alexander John A, Kwan Tina W, Garg Shilpi, Restrepo Humberto
Аннотация
OBJECTIVE: To report our experience in the state of Nevada with embedding fetal cardiologists in maternal-fetal-medicine (MFM) clinics and with the current prenatal detection of critical cardiovascular malformations (CCVMs).
METHODS: We queried our databases for CCVMs, diagnosed pre- or postnatally, and undergoing fetal demise, elective termination, or born between August 2024 and August 2025. We defined CCVMs as those that required or would have required a therapeutic procedure in the first 60 days.
RESULTS: We identified 70 cases. Of the 70, 66 (94%) had prenatal care. Of the 66 with prenatal care, 62 (94%) were diagnosed prenatally by embedded fetal cardiologists at MFM clinics. For the 62 pregnant women, the reasons for obstetric referrals to MFM care were: 34 (55%) with maternal comorbidities alone, 16 (25%) with maternal comorbidities and suspected fetal anomalies, 9 (15%) with suspected fetal anomalies alone, and 3 (5%) for initial fetal anatomical surveys without maternal comorbidities. For the 62 pregnant women, the indications for fetal cardiologist-attended fetal echocardiograms were: 53 (86%) with a suspected fetal cardiovascular malformation noted on a previous MFM perinatal sonographer's ultrasound, 4 (6%) with a suspected extracardiac fetal anomaly, 4 (6%) with previous poor visualization, and 1 (2%) with a family history of congenital heart disease.
CONCLUSIONS: In Nevada, the most recent prenatal detection of CCVMs was 94% statewide. Additionally, 95% of those prenatally diagnosed were products of high-risk pregnancies. Further, embedding fetal cardiologists in all MFM clinics has enhanced the skills of perinatal sonographers and maximized prenatal detection rates statewide.
METHODS: We queried our databases for CCVMs, diagnosed pre- or postnatally, and undergoing fetal demise, elective termination, or born between August 2024 and August 2025. We defined CCVMs as those that required or would have required a therapeutic procedure in the first 60 days.
RESULTS: We identified 70 cases. Of the 70, 66 (94%) had prenatal care. Of the 66 with prenatal care, 62 (94%) were diagnosed prenatally by embedded fetal cardiologists at MFM clinics. For the 62 pregnant women, the reasons for obstetric referrals to MFM care were: 34 (55%) with maternal comorbidities alone, 16 (25%) with maternal comorbidities and suspected fetal anomalies, 9 (15%) with suspected fetal anomalies alone, and 3 (5%) for initial fetal anatomical surveys without maternal comorbidities. For the 62 pregnant women, the indications for fetal cardiologist-attended fetal echocardiograms were: 53 (86%) with a suspected fetal cardiovascular malformation noted on a previous MFM perinatal sonographer's ultrasound, 4 (6%) with a suspected extracardiac fetal anomaly, 4 (6%) with previous poor visualization, and 1 (2%) with a family history of congenital heart disease.
CONCLUSIONS: In Nevada, the most recent prenatal detection of CCVMs was 94% statewide. Additionally, 95% of those prenatally diagnosed were products of high-risk pregnancies. Further, embedding fetal cardiologists in all MFM clinics has enhanced the skills of perinatal sonographers and maximized prenatal detection rates statewide.