Evaluating The Efficacy of Fetal Echocardiography and Ultrasonography in Prenatal Diagnosis of Congenital Heart Disease Compared to Post-Delivery Echocardiography

Background: Congenital heart disease (CHD) is the most common life-threatening neonatal cardiovascular disease with high prevalence up to 8 in 1000 livebirths. The disease considered as fundamental malformation of cardiac structure or great thoracic arteries. Prenatal diagnosis provides us a way to distinguish a cardiac lesion earlier also programming appropriate delivery termination. It is debatable whether it could be achieved better by ultrasonography (US) or fetal echocardiography methods. We aim to evaluate fetal echocardiography and ultrasonography findings in comparison with post-delivery echocardiography and confirm the more efficacy method for prenatal diagnosis of CHD. Methods: A retrospective cross-sectional study on 250 documents of referred pregnant women conducted in Imam Reza Hospital, Mashhad, Iran for 5 years. The reports of fetal US performed by radiologists and echocardiography by pediatric cardiologist evaluated in comparison with post-delivery echocardiography findings. Data were analyzed using SPSS ver.16. To assess the agreement between two methods using Cohen’s kappa coefficient. (k> 0.4, p<0.05) as the significant cut off. Also Sensitivity and specialty of each method was assessed. Results: In terms of comparing the results of fetal echocardiography with post-delivery echocardiography, only 7% of fetuses were not diagnosed as CHD prenatally including mild pulmonary stenosis or muscular ventricular septal defects. 55% of post-delivery CHDs were detected by fetal echocardiography and the remaining 45% were mostly VSDs which were then closed up spontaneously. The agreement in cardiac normality detection of fetal echocardiography with post-delivery findings were 92.85%. (p=0.23, kappa=0.2). The sensitivity and specificity of fetal echocardiography compared to postnatal echocardiography are 91.6% and 59.09%, respectively. In comparing ultrasonography with post-delivery echocardiography 36.3% of reported US cardiac abnormality confirmed after birth by echocardiography. The US agreement with post-delivery echo detection in cardiac normality detection were 50%. The sensitivity and specificity of US compared to post-delivery findings were 66.66% and 22.23%, respectively. Conclusion: Higher correlation was calculated in the results of fetal echocardiography than the ultrasonography in comparison with post-delivery echocardiography. There was no exact agreement in deterministic final diagnosis of both prenatal methods, although fetal echocardiography is remarkably more capable in accurate diagnosis .

کلیدواژه ها:

congenital heart disease ، ultrasonography ، prenatal diagnosis ، fetal ، echocardiography ، post-delivery echocardiography