Understanding the Limitations of Fetal Cardiac Imaging

Abstract

Congenital heart defects are among the most common fetal structural malformations, with a prevalence of 8 in 1,000 live births, and are a significant source of infant mortality. Women with low-risk pregnancies are screened for fetal cardiac disease by anatomical ultrasonographic surveys. Fetal echocardiography is typically reserved for pregnant women with a suspected fetal cardiac lesion based on fetal survey and pregnancies at high risk for fetal congenital heart defects. Prenatal diagnosis allows for collaboration and consultation with multiple services, improved recognition of associated extracardiac anomalies, and early detection of underlying genetic anomalies. Theoretically, prenatal diagnosis should offer opportunities to improve postnatal management and long-term outcomes. However, the evidence to suggest benefit to prenatal diagnosis is mixed and the benefit seems to be dependent on the specific cardiac lesion. To facilitate the appropriate utilization of fetal echocardiography, it is necessary to understand how the study is currently being performed, its cost considerations, and how clinicians and sonographers can use it effectively to ensure appropriate image acquisition and interpretation.