Role of prenatal fetal echocardiography in maternal medical disorders

Cardiac defects are the most common structural abnormalities seen in 8 per 1000 infants born alive. Prenatal diagnosis of a congenital cardio vascular malformation by fetal echocardiography influences the management of pregnancy, labour and delivery and post natal care. Prospective study was conducted on 180 pregnant women by fetal echocardiography at 20 weeks of gestation at Govt. R.S.R.M. Hospital, Royapuram, Chennai-13 with known risk factors for congenital heart disease in their offspring and with underlying maternal medical disorders. Four chamber view made out in 172 cases, congenital cardiac lesion were detected in 14 cases following detailed examination. Sensitivity 95.6%, Positive predictive value 92.5%, Specificity 22.2%, Negative predictive value 33.3% .Cardiac anomalies diagnosed in 18 cases diagnosed prenatally. Our sensitivity was 94%, specificity 100% positive predictive value 100%, positive negative value 91.7% .20 cases of lethal extra cardiac anomalies were detected one case of TRAP was diagnosed and in 81% cases showed normal karyotyping and 19% cases showed abnormal karyotyping. In all 20 cases of lethal anomalies termination was offered. For TRAP embolization was done for acardiac twin. 134 cases delivered vaginally, 25 cases LSCS done for obstetrics cause. Postnatal follow-up of two cases of fetus showed interventricualr septal thickness and cardiomyopathy died in utero. For VSD case autopsy done. All 11 live babies and the one case of VSD missed prenatally were referred to the cardiologist .Fetal echo is a useful noninvasive tool which can predict “Fetus at Risk“ whenever there is underlying maternal medical disorder.