Congenital heart disease (CHD) occurs in 4–13 per 1000 births in the United States. While many risk factors for CHD have been identified, more than 90% of cases occur in low-risk patients. Guidelines for fetal cardiac screening during the second trimester anatomy ultrasound have been developed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) in order to improve antenatal detection rates and to standardize the fetal cardiac screening examination. Patients found to be at increased risk of CHD because of risk factors or an abnormal screening examination should be referred for second trimester fetal echocardiography. Recently, 3D and 4D ultrasound techniques are being utilized to enhance detection rates and to better characterize cardiac lesions, and several first trimester ultrasound screening markers have been proposed to identify patients at increased risk of CHD. However, detection rates have not improved significantly due to limitations such as cost, access, and training that are associated with new technologies and screening methods. The most cost effective way to improve detection rates of CHD may be to standardize screening protocols across practices according to established guidelines and to have a low threshold for referral for fetal echocardiography.
Obstetricians and gynecologists, family physicians
After completing this activity, the learner should be better able to: (1) Implement ISUOG guidelines for the basic fetal cardiac exam into clinical practice; (2) Select patients appropriately for referral for fetal echocardiography; and (3) Understand the most commonly used 3D and 4D ultrasound techniques used to evaluate the structure and function of the fetal heart.