Fetal Echocardiography Indications and Lack of Association between Abnormal Exams and Advanced Maternal Age: A Cross-Sectional Study - Fetal Abnormal Echocardiography

Abstract

Objective To analyze the most frequent referrals for fetal echocardiography, including advanced maternal age and its association with abnormal results.

Methods We included all pregnant women referred to perform fetal echocardiography (gestational age 22–32 weeks) in 2 health centers in Rio de Janeiro, from June 2015 to June 2016. Advanced maternal age was considered when age was > 35 years at the time of delivery). Referral reasons and results were recorded, according to the Brazilian Fetal Cardiology Statement. Crude and adjusted prevalence ratios were calculated (Poisson regression). We considered p < 0.05 as significant.

Results A total of 1,221 tests were analyzed. Abnormal fetal echocardiography was observed in 14.82% of the cases. The most frequent abnormalities were interventricular septal defect (6.39%), septal hypertrophy (3.35%) and atrioventricular septal defect (1.14%). Routine exams were performed in 559 women, 289 were referred for advanced maternal age and 373 were referred according to the Brazilian Fetal Cardiology Statement criteria. An obstetric ultrasound suggesting fetal cardiac abnormality, maternal diabetes, increased nuchal translucency, and obstetric ultrasound suggesting a noncardiac abnormality were strongly associated with an abnormal fetal echocardiography. Abnormal results were not more frequent in women with advanced maternal age when compared with the rest of the study group.

Conclusions It was observed that routine exams and advanced maternal age referrals were very frequent. Those exams were not associated to fetal echocardiography abnormalities. In this scenario, when the obstetric ultrasound suggests a fetal cardiac abnormality, the fetal echocardiography probably is abnormal. Therefore, obstetric ultrasound is a good screening method.

Resumo

Objetivo Analisar as indicações mais frequentes para realização de ecocardiografia fetal, incluindo idade materna avançada, e a associação destas com exames alterados.

Métodos Foram incluídas todas as gestantes que realizaram ecocardiografia fetal na idade gestacional entre 22 e 32 semanas, em 2 centros de referência no Rio de Janeiro, no período de junho de 2015 a junho de 2016. Foi considerada idade materna avançada se no momento do parto a idade materna fosse > 35 anos. As indicações e os resultados dos exames foram registrados, segundo a Diretriz Brasileira de Cardiologia Fetal. Foram calculadas as razões de prevalência brutas e ajustadas através da regressão de Poisson, considerando-se p < 0,05.

Resultados Um total de 1.221 exames foram analisados. A frequência de exame ecocardiográfico alterado foi 14,82%. As alterações mais frequentes foram defeito do septo interventricular (6,39%), hipertrofia septal (3,35%) e defeito do septo atrioventricular (1,14%). Quinhentos e cinquenta e nove exames foram realizados com indicação de rotina, 289 por idade materna avançada e 373 preenchiam critério de acordo com a Diretriz Brasileira de Cardiologia Fetal. O exame ecocardiográfico alterado foi associado ao ultrassom obstétrico sugerindo cardiopatia fetal, ao diabetes materno, à translucência nucal aumentada e ao ultrassom obstétrico sugerindo alteração extracardíaca. Não foi observada maior frequência de exame ecocardiográfico alterado nas gestantes com idade materna avançada, comparado ao restante da amostra.

Conclusão Constatou-se elevada frequência de indicações de rotina, e por idade materna avançada isoladamente, que não foram associados a alterações da ecocardiografia fetal. Em nosso meio, quando o ultrassom obstétrico sugere cardiopatia fetal, é muito provável que a ecocardiografia fetal também seja anormal. Portanto, o ultrassom obstétrico é um bom método de rastreio pré-natal.

Keywords

congenital heart disease - prenatal diagnosis - fetal heart - fetal ultrasonography

Palavras-chave

cardiopatias - cuidado pré-natal - coração fetal - ultrassonografia pré-natal

Contributions

All authors participated in the concept and design of the present study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.

Publikationsverlauf

Eingereicht: 13. April 2020

Angenommen: 12. August 2020

Artikel online veröffentlicht:
21. Dezember 2020

• References

• 1 Cha S, Kim GB, Kwon BS, Bae EJ, Noh CI, Lim HG. et al. Recent trends in indications of fetal echocardiography and postnatal outcomes in fetuses diagnosed as congenital heart disease. Korean Circ J 2012; 42 (12) 839-844
• 2 Alves Rocha L, Araujo Júnior E, Rolo LC, Barros FSB, Silva KP, Martinez LH. et al. Screening of congenital heart disease in the second trimester of pregnancy: current knowledge and new perspectives to the clinical practice. Cardiol Young 2014; 24 (03) 388-396
• 3 Hunter LE, Simpson JM. Prenatal screening for structural congenital heart disease. Nat Rev Cardiol 2014; 11 (06) 323-334
• 4 Allan LD. Echocardiographic detection of congenital heart disease in the fetus: present and future. Br Heart J 1995; 74 (02) 103-106
• 5 Słodki M, Respondek-Liberska M, Pruetz JD, Donofrio MT. Fetal cardiology: changing the definition of critical heart disease in the newborn. J Perinatol 2016; 36 (08) 575-580
• 6 Wright L, Stauffer N, Samai C, Oster M. Who should be referred? An evaluation of referral indications for fetal echocardiography in the detection of structural congenital heart disease. Pediatr Cardiol 2014; 35 (06) 928-933
• 7 Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A. et al; American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129 (21) 2183-2242
• 8 Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVB, Guimarães ICB. et al. Diretriz Brasileira de Cardiologia Fetal. Arq Bras Cardiol 2019; 112 (05) 600-648
• 9 Mehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M. et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth 2020; 20 (01) 60
• 10 Best KE, Rankin J. Is advanced maternal age a risk factor for congenital heart disease?. Birth Defects Res A Clin Mol Teratol 2016; 106 (06) 461-467
• 11 Rocha LA, Araujo Júnior E, Rolo LC, Barros FSB, Silva KP, Leslie ATFS. et al. Prenatal detection of congenital heart diseases: one-year survey performing a screening protocol in a single reference center in Brazil. Cardiol Res Pract 2014; 2014: 175635
• 12 Stümpflen I, Stümpflen A, Wimmer M, Bernaschek G. Effect of detailed fetal echocardiography as part of routine prenatal ultrasonographic screening on detection of congenital heart disease. Lancet 1996; 348 (9031): 854-857
• 13 Persico N, Moratalla J, Lombardi CM, Zidere V, Allan L, Nicolaides KH. Fetal echocardiography at 11-13 weeks by transabdominal high-frequency ultrasound. Ultrasound Obstet Gynecol 2011; 37 (03) 296-301
• 14 Hagemann LL, Zielinsky P. Rastreamento populacional de anormalidades cardíacas fetais por ecocardiografia pré-natal em gestações de baixo risco no município de Porto Alegre. Arq Bras Cardiol 2004; 82 (04) 313-319
• 15 Nayak K, Chandra G S N, Shetty R, Narayan PK. Evaluation of fetal echocardiography as a routine antenatal screening tool for detection of congenital heart disease. Cardiovasc Diagn Ther 2016; 6 (01) 44-49
• 16 Perri T, Cohen-Sacher B, Hod M, Berant M, Meizner I, Bar J. Risk factors for cardiac malformations detected by fetal echocardiography in a tertiary center. J Matern Fetal Neonatal Med 2005; 17 (02) 123-128
• 17 Ozkutlu S, Akça T, Kafali G, Beksaç S. The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects. Anadolu Kardiyol Derg 2010; 10 (03) 263-269
• 18 Meyer-Wittkopf M, Cooper S, Sholler G. Correlation between fetal cardiac diagnosis by obstetric and pediatric cardiologist sonographers and comparison with postnatal findings. Ultrasound Obstet Gynecol 2001; 17 (05) 392-397
• 19 Friedberg MK, Silverman NH. Changing indications for fetal echocardiography in a University Center population. Prenat Diagn 2004; 24 (10) 781-786
• 20 Sainz JA, Zurita MJ, Guillen I, Borrero C, García-Mejido J, Almeida C. et al. [Prenatal screening of congenital heart defects in population at low risk of congenital defects. A reality today]. An Pediatr (Barc) 2015; 82 (01) 27-34
• 21 Dervisoglu P, Kosecik M, Kumbasar S. Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study. J Obstet Gynaecol 2018; 38 (03) 408-412
• 22 Appiah D, Schreiner PJ, Gunderson EP, Konety SH, Jacobs Jr DJ, Nwabuo CC. et al. Association of gestational diabetes mellitus with left ventricular structure and function: the CARDIA Study. Diabetes Care 2016; 39 (03) 400-407
• 23 Hernandez-Andrade E, Patwardhan M, Cruz-Lemini M, Luewan S. Early evaluation of the fetal heart. Fetal Diagn Ther 2017; 42 (03) 161-173
• 24 Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3: 21
• 25 Prefeitura Municipal do Rio de Janeiro. Secretaria Municipal de Saúde, Coordenação de Análise da Situação de Saúde. Indicadores de Saúde de Residentes no Município do Rio de Janeiro, 2010–2019 [Internet]. 2010 [cited 2020 Jan 12]. Available from: http://www.rio.rj.gov.br/dlstatic/10112/7629558/4258614/IndicadoresNascimentoeMortalidade2010_2019_MRJ_06_09_19.pdf