Background

The aim of this study was to examine the diagnostic yield of current fetal echocardiography (FE) indications representing a recent era.

Methods

FE reports of all pregnancies referred to two provincial FE programs from 2009 to 2018 were examined, identifying the indication for FE (14 categories), gestational age at referral, and whether there was no fetal heart disease (FHD), mild or possible FHD (e.g., simple ventricular septal defect, possible coarctation), or moderate or severe FHD.

Results

Over the study period, there were 19,310 unique FE referrals in Alberta (23.3 ± 5.4 weeks’ gestation), including 1,907 (9.9%) with moderate or severe and 654 (3.4%) with mild or possible FHD. The most common referral indications included extracardiac pathology or markers (29.7%), maternal diabetes (18.3%), suspected FHD (17.7%), and family history of heart defects (17.7%). The highest yield for moderate or severe FHD was suspected FHD (41.1%; 95% CI, 39.4%–42.7%), followed by suspected or confirmed genetic disorder (15.4%; 95% CI, 12.6%–18.2%), twins or multiples (10.6%; 95% CI, 8.7%–12.5%), oligohydramnios (8.0%; 95% CI, 4.1%–11.9%), extracardiac pathology or markers (6.4%; 95% CI, 5.8%–7.1%), and heart not well seen (5.8%; 95% CI, 4.0%–7.6%). Lowest yields were observed for maternal diabetes (2.2%; 95% CI, 1.7%–2.7%) and family history of heart defects (1.7%; 95% CI, 1.3%–2.2%). Excluding suspected FHD, with two or more FE indications, all other indications demonstrated significant increases in yield of mild or possible (3.5% vs 1.9%, P < .001) and moderate or severe (7.2% vs 2.9%, P < .001) FHD.

Conclusions

Suspected FHD provides the highest diagnostic yield of moderate or severe FHD. In contrast, maternal diabetes and family history of heart defects, among the most common referral indications, had diagnostic yields approaching general population risks. Even in the absence of suspected FHD, having two or more referral indications importantly increases the diagnostic yield of all other FE indications.

中文翻译：

---

当前时代胎儿超声心动图适应症的诊断率

背景

本研究的目的是检查代表最近时代的当前胎儿超声心动图 (FE) 适应症的诊断率。

方法

对 2009 年至 2018 年两个省级 FE 项目的所有妊娠的 FE 报告进行了检查，确定了 FE 的适应症（14 类）、转诊时的胎龄以及是否有胎儿心脏病（FHD）、轻度或可能的 FHD（例如，简单的室间隔缺损、可能的缩窄）或中度或重度 FHD。

结果

在研究期间，阿尔伯塔省有 19,310 例独特的 FE 转诊（妊娠 23.3 ± 5.4 周），其中 1,907 例（9.9%）患有中度或重度，654 例（3.4%）患有轻度或可能的 FHD。最常见的转诊指征包括心外病变或标志物（29.7%）、产妇糖尿病（18.3%）、疑似 FHD（17.7%）和心脏缺陷家族史（17.7%）。中度或重度 FHD 的最高产率是疑似 FHD（41.1%；95% CI，39.4%–42.7%），其次是疑似或确诊的遗传疾病（15.4%；95% CI，12.6%–18.2%）、双胞胎或倍数（10.6%；95% CI，8.7%–12.5%），羊水过少（8.0%；95% CI，4.1%–11.9%），心外病变或标志物（6.4%；95% CI，5.8%–7.1%） , 心脏不明显 (5.8%; 95% CI, 4.0%–7.6%)。观察到孕产妇糖尿病的产量最低（2.2%；95% CI，1.7%–2. 7%）和心脏缺陷家族史（1.7%；95% CI，1.3%–2.2%）。排除有两个或更多 FE 适应症的疑似 FHD，所有其他适应症均显示轻度或可能的产量显着增加（3.5% 对 1.9%，P  < .001）和中度或重度（7.2% vs 2.9%，P  < .001）FHD。

结论

疑似 FHD 对中度或重度 FHD 的诊断率最高。相比之下，在最常见的转诊适应症中，产妇糖尿病和心脏缺陷家族史的诊断率接近一般人群的风险。即使在没有疑似 FHD 的情况下，拥有两个或更多转诊指征也能显着提高所有其他 FE 指征的诊断率。