Embedding Fetal Cardiologists in Maternal‐Fetal‐Medicine Clinics and Near Universal State‐Wide Detection of Critical Cardiovascular Malformations

OBJECTIVE: To report our experience in the state of Nevada with embedding fetal cardiologists in maternal-fetal-medicine (MFM) clinics and with the current prenatal detection of critical cardiovascular malformations (CCVMs). METHODS: We queried our databases for CCVMs, diagnosed pre- or postnatally, and undergoing fetal demise, elective termination, or born between August 2024 and August 2025. We defined CCVMs as those that required or would have required a therapeutic procedure in the first 60 days. RESULTS: We identified 70 cases. Of the 70, 66 (94%) had prenatal care. Of the 66 with prenatal care, 62 (94%) were diagnosed prenatally by embedded fetal cardiologists at MFM clinics. For the 62 pregnant women, the reasons for obstetric referrals to MFM care were: 34 (55%) with maternal comorbidities alone, 16 (25%) with maternal comorbidities and suspected fetal anomalies, 9 (15%) with suspected fetal anomalies alone, and 3 (5%) for initial fetal anatomical surveys without maternal comorbidities. For the 62 pregnant women, the indications for fetal cardiologist-attended fetal echocardiograms were: 53 (86%) with a suspected fetal cardiovascular malformation noted on a previous MFM perinatal sonographer's ultrasound, 4 (6%) with a suspected extracardiac fetal anomaly, 4 (6%) with previous poor visualization, and 1 (2%) with a family history of congenital heart disease. CONCLUSIONS: In Nevada, the most recent prenatal detection of CCVMs was 94% statewide. Additionally, 95% of those prenatally diagnosed were products of high-risk pregnancies. Further, embedding fetal cardiologists in all MFM clinics has enhanced the skills of perinatal sonographers and maximized prenatal detection rates statewide.