Antenatal Diagnosis of Congenital Heart Disease

Ashish Jain, Gaurav Mandhan

Abstract

The prevalence of congenital heart diseases (CHDs) is underreported, especially in developing countries. Antenatal screening of CHDs helps in reducing the perinatal mortality and improving the outcomes of these neonates. Antenatal screening for CHDs should be performed routinely in all pregnancies using the basic 4-chamber view during the first trimester (ie, 12–13+6 weeks of gestation). However, high-risk pregnancies should be offered 2-step screening that includes 4-chamber and extended echocardiographic (ECHO) views both in the first and second trimesters. According to the American Heart Association, 18 to 22 weeks of gestation is ideal to perform fetal ECHO. There are chances of missing the subtle cardiac lesions in the first trimester screening. Pregnancies diagnosed with CHDs should be closely monitored by a pediatric cardiologist. At least one follow-up ECHO should be performed during the last trimester. Perinatal categorization should be done for life-threatening conditions, and appropriate management should be planned before delivery. Such fetuses should be delivered in level-3 NICU with attached pediatric cardiac units. Antenatally diagnosed fetal CHDs should be evaluated and followed up systematically by a pediatric cardiologist.