1
|
Nigam P, Weinberger S, Srivastava S, Lorber R. The evolution of fetal echocardiography before and during COVID-19. PROGRESS IN PEDIATRIC CARDIOLOGY 2020; 58:101259. [PMID: 32837145 PMCID: PMC7306716 DOI: 10.1016/j.ppedcard.2020.101259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/27/2022]
Abstract
The World Health Organization declared the novel coronavirus, or COVID-19, a pandemic in March 2020. Given the severity of COVID-19, appropriate use criteria have been implemented for fetal echocardiography. Screening low risk pregnancies for critical congenital heart disease has typically been a shared responsibility by pediatric cardiologists, obstetricians, and maternal fetal medicine (MFM). Currently, many of the fetal echocardiograms for low risk pregnancies for critical congenital heart disease have been deferred or cancelled with the emphasis on suspected abnormalities by MFMs and obstetricians. In this review, we discuss the literature that has been the basis of screening of low risk pregnancies by pediatric cardiologists. A new approach to more widespread usage of fetal tele-echocardiography may play a large part during COVID-19 and may continue after the pandemic. Appropriate use criteria for fetal echocardiography have been implemented during the COVID-19 pandemic. Pediatric cardiologists have deferred fetal echo for low risk pregnancies, emphasizing those with suspected abnormalities. Current fetal echo guidelines highlight maternal, familial, and fetal risk factors, and the associated incidence of CHD. Fetal tele-echocardiography and telehealth consultation may enhance the ability to provide care during and beyond COVID-19.
Collapse
Affiliation(s)
- Priya Nigam
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States of America
| | - Sharon Weinberger
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States of America
| | - Shubhika Srivastava
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States of America
| | - Richard Lorber
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States of America
| |
Collapse
|
2
|
Emami-Moghaddam A, Barati M, Amirpour R, Shojaei K. Prenatal and postnatal echocardiography in NT fetuses with normal karyotype. J Family Med Prim Care 2019; 8:2667-2670. [PMID: 31548952 PMCID: PMC6753816 DOI: 10.4103/jfmpc.jfmpc_395_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/28/2019] [Accepted: 07/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Targeted fetus echocardiography at midpregnancy can detect major defects in major cardiovascular organs. The present study aimed to evaluate prenatal and postnatal echocardiography in fetuses with increased nuchal translucency (NT) with normal karyotype. METHODS In this retrospective study, data on the screening of fetuses in pregnant women between 2014 and 2015 were evaluated. The fetuses at the gestational age were 14-11 weeks, and NT ≥ 95 percentile (or 3 mm). For all fetuses with increased NT, follow-up anomaly scan was performed at 18-22 weeks of pregnancy, while fetal echocardiography was performed at weeks 16-19 of pregnancy. The results were analyzed by Statistical Package for the Social Sciences (version 22) and the level of significance was less than 0.05. RESULTS A total of 26.27% of the fetuses were diagnosed with prenatal heart defects and confirmed after birth. The strongest relationship was observed between increased NT and the diagnosis of prenatal heart defects at 2.5-5.3 mm. The increased NT was higher in younger mothers. Moreover, increased NT was higher in mothers with less body mass index. CONCLUSION By measuring NT in the 11-13 weeks of pregnancy and considering the risk factors, it is possible to evaluate the probability of cardiac abnormalities in the fetus and perform the necessary diagnostic evaluations for high-risk cases.
Collapse
Affiliation(s)
| | - Mojgan Barati
- Fertility Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razie Amirpour
- Fertility Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kobra Shojaei
- Fertility Infertility and Perinatology Research Center, Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
3
|
Abstract
The American Congress of Obstetricians and Gynecologists recommends that all pregnant women be offered aneuploidy screening or diagnostic testing. A myriad of screening and testing options are available to patients based on their risk profile and gestational age. Screening options include traditional serum analyte screening, such as first-trimester screening or quadruple screening, and more recently, cell-free DNA. Diagnostic testing choices include chorionic villus sampling and amniocentesis. The number of screening and diagnostic modalities complicates prenatal counseling for physicians and can be difficult for patients to grasp. Appropriate pretest and posttest counseling is important to ensure adequate understanding of results and ensure testing strategy is concordant with patient goals.
Collapse
Affiliation(s)
- Laura M Carlson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3010 Old Clinic Building, CB #7516, Chapel Hill, NC 27599-7516, USA.
| | - Neeta L Vora
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3010 Old Clinic Building, CB #7516, Chapel Hill, NC 27599-7516, USA
| |
Collapse
|
4
|
Simplified protocol of nuchal translucency measurement: Is it still effective? Obstet Gynecol Sci 2013; 56:307-11. [PMID: 24328020 PMCID: PMC3784130 DOI: 10.5468/ogs.2013.56.5.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 04/19/2013] [Accepted: 05/16/2013] [Indexed: 11/20/2022] Open
Abstract
Objective Nuchal translucency (NT) is the most powerful screening tool for Down syndrome and congenital cardiac anomaly, therefore strict guidelines were established to get accurate NT values. However, to stick to the guideline in all pregnant women is time-consuming and superfluous in majority of low risk population. We undertook this study to investigate whether the simplified protocol enables to select low risk group and is effective in them even if we skip the suggested NT measurement. Methods NT and crown-rump length (CRL) were measured prospectively. First, CRL was measured in the ordinary view that was mid-sagittal section of fetus in neutral position, and NT was measured at the same frozen screen (first measured value, 1MV). Then, NT was measured again according to the Fetal Medicine Foundation (FMF) guideline (second measured value, 2MV). Results There was good correlation between 1MV and 2MV in each case (r = 0.83, P < 0.001). All of the NT values over the 95th percentile in 2MV also belonged to over the 95th percentile in 1MV. NT value of 2 mm in 1MV could be used as a cut-off to obtain over the 95th percentile 2MV by receiver operating characteristic curve (sensitivity 100%, specificity 80.5%). The proportion of 1MV ≥ 2 mm was only 23.8% of all cases, namely we had only to measure 2MV in 23.8% patients. Every 95th percentile or more 2MV could be detected with this simplified protocol. Conclusion If NT is less than 2 mm at ordinary CRL view, we may skip suggested NT measurement according to FMF guideline.
Collapse
|
5
|
Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K. Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis. PLoS One 2013; 8:e65484. [PMID: 23750263 PMCID: PMC3672155 DOI: 10.1371/journal.pone.0065484] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/26/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols. METHODS We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance. RESULTS We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively. CONCLUSION These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.
Collapse
Affiliation(s)
- Yifei Li
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Fang
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Lina Qiao
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaomin Wan
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education Key Laboratory of Women and Children’s Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Saha S, Paoletti D, Robertson M. Persistent left superior vena cava - considerations in fetal, pediatric and adult populations. Australas J Ultrasound Med 2012; 15:61-66. [PMID: 28191144 PMCID: PMC5025113 DOI: 10.1002/j.2205-0140.2012.tb00228.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Persistent left superior vena cava (LSVC) is the commonest congenital anomaly of the thoracic venous system. It is within the group of anomalous systemic venous return (ASVR) and the group is subdivided in cephalic, involving the superior vena cava (SVC) and caudal, involving the inferior vena cava (IVC) types. It is also important to recognise that there can be a persistent LSVC with or without a normal right superior vena cava (RSVC). In most cases, a persistent LSVC drains into the right atrium via the coronary sinus without any clinical symptoms. In this article we discuss embryology, diagnostic and further management approaches and a review of the literature related to persistent LSVC.
Collapse
Affiliation(s)
- Sumi Saha
- Department of Obstetrics and Gynaecology Australian National University Medical School Canberra Australian Capital Territory 0200 Australia
| | - Debra Paoletti
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory 2605 Australia
| | - Meiri Robertson
- Department of Obstetrics and GynaecologyAustralian National University Medical SchoolCanberraAustralian Capital Territory0200Australia; Fetal Medicine Unit Division of Women Youth and ChildrenCanberra HospitalGarranAustralian Capital Territory2605Australia
| |
Collapse
|