Evaluation Fetal Heart in the First and Second Trimester: Results and Limitations

Abstract

Background: Cardiac heart defects affect nearly 6–12 per 1000 live births in the general population and are more frequent than common  trisomies.

Aim: To assess the efficacy and technical limitations of first‑trimester fetal heart evaluation in the 11–14th-weeks’ scan and  comparison with the second-trimester anatomical exam by ultrasound.

Material and Method: Between April 2015 and July 2020, medical  records and ultrasound data of 3295 pregnancies who underwent first‑trimester fetal anatomy exams by ultrasound were reviewed  retrospectively. All ultrasound exams were performed by the same two operators (TUKD, OP) with transabdominal transducers. Fetal  situs, four‑chamber view, outflow tracts, and three‑vessel trachea view are the cornerstones of first‑trimester fetal heart examination.  Conventional grayscale mode and high‑definition power Doppler mode were utilized. The same operators re‑examined all cases between  the 18 and 23 weeks of gestation by ISUOG guidelines.

Results: We performed a combined transvaginal and transabdominal approach  for only 101 cases (3.06%). The mean maternal age was 31.28 ± 4.43, the median gestational age at the first‑trimester ultrasound exam  was 12.4 weeks, and the median CRL was 61.87 mm (range was 45.1–84 mm). Even combined approach situs, cardiac axis, and  four‑chamber view could not be visualized optimally in 28 cases (0.7%). Outflow tracts were visualized separately in 80% (2636 in 3295)  cases. Three vessel-trachea views were obtained in 85.4% (2814 in 3295) cases by high‑definition Doppler mode. There were 47 fetuses  with cardiac defects in 3295 pregnancies with the known pregnancy outcome. Ten cases had abnormal karyotype results. Thirty-two fetuses with cardiac anomalies (9.7 in 1000 pregnancies) were detected in the first‑trimester examination, and the remaining 15 (4.55 in  1000 pregnancies) cases were diagnosed in the second‑trimester examination. The prevalence of congenital cardiac anomalies was 14.25  in 1000 pregnancies. Fifteen cases were missed in the first‑trimester exam. Also, ten fetuses which had abnormal cardiac findings in the  first‑trimester exam were not confirmed in the second‑trimester exam. Sensitivity, specificity, positive, and negative predictive values  were calculated as 65.3%, 99.7%, 66.8%, and 99.67%, respectively.

Conclusion: Late first‑trimester examination of the fetus is feasible and  allows earlier detection of many structural abnormalities of the fetus, including congenital heart defects. Suspicious and isolated cardiac  abnormal findings should be re‑examined and confirmed in the second‑trimester exam. Previous abdominal surgery, high BMI, and  subtle cardiac defects can cause missed cardiac abnormalities.