Indications and findings of fetal echocardiography: a retrospective analysis of a high-risk cohort in a polish center

Objectives: Fetal echocardiography (FE) is a critical diagnostic tool for assessing cardiac and extracardiac abnormalities in high-risk pregnancies. In this paper we evaluate indications and findings of FE in a high-risk cohort at a Polish fetal echocardiography clinic. Material and methods: This retrospective, observational cohort study included 991 patients undergoing FE between January 2023 and December 2024. A single prenatal cardiologist with extensive FE experience performed all examinations. Indications and findings were analyzed, with results categorized into subgroups. Results: Mean maternal age was 31.6 years (SD 5.3), with a median gestational age of 26 weeks (IQR = 4). The most frequent indications were intermediate risk of chromosomal aberrations from first-trimester screening (17.76%), intra-cardiac echogenic foci (13.32%), and elevated risk of chromosomal aberrations (12.82%), comprising 43.69% of referrals. Normal FE results were observed in 88.49% of cases (n = 877). Abnormalities (cardiac or extracardiac) occurred in 11.51%, with cardiac abnormalities in 7.16% (71 cases: 3.12% structural, 4.03% functional). Ventricular septal defect (1%) and arrhythmias (1.31%) were the most common structural and functional findings, respectively. Extracardiac abnormalities with normal cardiac imaging occurred in 4.3%. No significant differences in abnormality prevalence were found between high/intermediate chromosomal risk groups and the cohort (odds ratios: 0.47–1.14). Conclusions: First-trimester screening results and soft markers predominantly drove FE referrals. The 11.51% abnormality rate underscores the importance of FE in high-risk pregnancies, despite no significant association with chromosomal risk levels.