FETAL ECHOCARDIOGRAPHY FOR RISKY PREGNANCIES IN SULAIMANI GOVERNORATE
Keywords:Fetal echo, Congenotal heart disease, Gestational age
Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiacanomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may alsolead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the post natal outcome.Morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries.
The aim of this prospective study is to evaluate our experience and results of fetal echo for high risk pregnancies in sulaimani city.
This is prospective descriptive study conducted on 450 pregnant ladies refered for fetal echocardiography from obstetricians , ultrasonographers and (self referral) from the 1st January 2013 to 1st the February 2017. Echocardiography done with Siemens machine with semicurved phased array probe at their first visit at 16-22 weeks in 330 ladies, at 22-28 weeks in 70 cases and at 31 weeks and above in 50 ladies. Also 2nd visit echo done for 60 patients for follow up at 31-33 weeks gestation. All babies checked post labour for accuracy of the diagnoses.
Among 450 pregnant ladies, 98 cases found to have abnormal findings , of which 27 diagnosed as hypertrophic cardiomyopathy ( just one persist after 6 months post labour), 25 cases as ASD (just 10 left true ASD postlabour), 14 diagnosed as tricuspid atersia and single ventricle physiology, 5 AVSD , 5 arrhythmia with hydropis , 5 with MV and TV abnormalities, 4 AS, 3 hypoplastic left heart syndrome, 3 PS, 2 l-TGA and one Coa . For cases whom classify as low risk populations of defects no action undertaken, for high risk population decision for termination wan one of the options. 2 miss diagnosis observed after labour checking among anomalies observed echo findings and they were of low risk cases, and no miss diagnosis observed in major risk group diagnosed cases. Fetal echocardiography examination specifity was sensitivity as 97.9% and specifity as 99.4% which is within 95% CI, positive predictive value was 97.9%, negative predictive value was 99.4% in which both within 95% CI.
The present study showed that fetal echo has great value in detection of congenital heart disease, prognosis and outcome in high risk pregnancies. It’s recommended to familiarize our obstetrician about this important diagnostic test. We should train our ultrasonographer and pediatric cardiologist to increase awareness about this diagnostic test (is it screening test,or a diagnostic test). Also as far as we know this the first paper written on this kind of diagnostic technique , so more studies need to be conducted in the future.
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