Does routine ultrasound examination of the fetal heart using the four-chamber view improve the detection and referral of severe congenital cardiac abnormalities?
Routine incorporation of the four-chamber view in obstetric ultrasound screening significantly aids in the early prenatal detection and referral of severe congenital heart malformations.
Routine ultrasound examination of the fetus is already established in most obstetric units in Britain. A simple method was devised to evaluate one section of the fetal heart systematically. Examination of this section, the four chamber view, may readily be incorporated into routine obstetric screening. Severe cardiac abnormalities detectable in this view occur in two per 1000 pregnancies. For six years the department of paediatric cardiology at Guy's Hospital, London, served as a referral centre for fetal echocardiography. As teaching became more widespread an increasing proportion of cases of cardiac anomaly were referred because the obstetrician suspected abnormality on examination of the four chamber view. Currently 80% of detected abnormalities are referred for this reason. Further extension and organisation of teaching might result in most severe cardiac malformations being detected in early prenatal life.
Allan et al. (1986) studied this question.