Fetal heart screening in low-risk pregnancies

Ultrasound Obstet Gynecol. 1995 Nov;6(5):313-9. doi: 10.1046/j.1469-0705.1995.06050313.x.


The aim of this study was to assess whether a screening program for fetal cardiac malformations is justified in a low-risk population, and which factors influence its accuracy. The fetal heart was evaluated in 7024 pregnant women at 20-22 weeks, and evaluation was repeated at a more advanced gestational age in 9% of cases. Cardiological follow-up was continued postnatally until 2 years of age. The overall prevalence of cardiac anomaly was 0.93%. The incidences of major and minor defects were 0.44% and 0.48%, respectively. There were 23 true positives (0.33%): in 20 cases, the diagnosis was made in the second trimester, and 13 women (65%) chose termination of pregnancy. Seventeen of the 20 cases identified in the second trimester were serious malformations. There were 42 false negatives (0.60%). Of these, 12 had signs of cardiac dysfunction at birth or within the 1st month of life, and three of them died as a result of their cardiac anomaly. There were eight false positives (0.11%), all of a minor type. Six abnormal karyotypes, out of a total of 21 performed in the true-positive group (28.5%), were found. In addition, five of the 42 newborns in the false-negative group had trisomy 21. The overall sensitivity was 35.4%, and 61.3% for major defects. The accuracy in two distinct periods was estimated because the level of experience of the operators was different: sensitivity was 45.2% in period 1 (1986-88) (77.8% for major defects) and 26.5% in period 2 (1989-92) (52.9% for major defects). We conclude that a fetal heart screening program in the obstetric population is justified. It defines a high-risk group for karyotyping, allows planning of delivery in a tertiary center or the choice of terminating the pregnancy for the parents and appears to have a positive cost-benefit ratio. A crucial factor is the level of training and experience of the operators, who need specific teaching support.

MeSH terms

  • Adolescent
  • Adult
  • Cost-Benefit Analysis
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Fetal Heart / diagnostic imaging*
  • Follow-Up Studies
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / epidemiology
  • Heart Defects, Congenital / prevention & control
  • Humans
  • Incidence
  • Longitudinal Studies
  • Mass Screening*
  • Pregnancy
  • Pregnancy Outcome*
  • Risk Factors
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal* / economics