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Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease.

Publication ,  Journal Article
Komisar, J; Srivastava, S; Geiger, M; Doucette, J; Ko, H; Shenoy, J; Shenoy, R
Published in: Congenit Heart Dis
January 2017

BACKGROUND: Antenatal diagnosis of congenital heart defects (CHD) can impact outcomes in neonates with severe CHD. Obstetric screening guidelines and the indications for fetal echocardiography (FE) have evolved in an attempt to improve the early prenatal detection of CHD. Analyzing yield for specific indications will help clinicians better stratify at-risk pregnancies. METHODS: Retrospective cohort study of all FE performed between 2000 and 2010 at a single tertiary care academic medical center in New York City. A total of 9878 FE met inclusion criteria for our study. In cases of multiple gestations (MG), each fetus was counted as a separate study. RESULTS: The number of new diagnosis of fetal CHD by FEs increased 200%. There was a statistically significant increase in those referred for suspected CHD, increased nuchal translucency (NT), MG, and suboptimal imaging (P < .001). The indication of "suboptimal imaging" (SO) not only accounted for 5.23% of all referrals from 2000 to 2002, compared to 22.26% of all referrals from 2008 to 2010 (P < .0001), but also had the lowest yield for diagnoses of CHD (P < .02). CONCLUSIONS: Over the past decade, there has been an increase in utilization of FE with a proportional increase in prenatally diagnosed CHD. For indications such as suspected CHD, NT and MG increases in referrals have led to a proportionate increase in fetal diagnosis of CHD. SO as an indication has the lowest yield of fetal diagnosis of CHD. Antenatal detection of CHD may be improved by a change in obstetric imaging protocols to ensure appropriate referrals.

Duke Scholars

Published In

Congenit Heart Dis

DOI

EISSN

1747-0803

Publication Date

January 2017

Volume

12

Issue

1

Start / End Page

67 / 73

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Time Factors
  • Tertiary Care Centers
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Pregnancy
  • Predictive Value of Tests
  • Practice Patterns, Physicians'
  • New York City
 

Citation

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Komisar, J., Srivastava, S., Geiger, M., Doucette, J., Ko, H., Shenoy, J., & Shenoy, R. (2017). Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease. Congenit Heart Dis, 12(1), 67–73. https://doi.org/10.1111/chd.12405
Komisar, Jonathan, Shubhika Srivastava, Miwa Geiger, John Doucette, Helen Ko, Jay Shenoy, and Rajesh Shenoy. “Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease.Congenit Heart Dis 12, no. 1 (January 2017): 67–73. https://doi.org/10.1111/chd.12405.
Komisar J, Srivastava S, Geiger M, Doucette J, Ko H, Shenoy J, et al. Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease. Congenit Heart Dis. 2017 Jan;12(1):67–73.
Komisar, Jonathan, et al. “Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease.Congenit Heart Dis, vol. 12, no. 1, Jan. 2017, pp. 67–73. Pubmed, doi:10.1111/chd.12405.
Komisar J, Srivastava S, Geiger M, Doucette J, Ko H, Shenoy J, Shenoy R. Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease. Congenit Heart Dis. 2017 Jan;12(1):67–73.
Journal cover image

Published In

Congenit Heart Dis

DOI

EISSN

1747-0803

Publication Date

January 2017

Volume

12

Issue

1

Start / End Page

67 / 73

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Time Factors
  • Tertiary Care Centers
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Pregnancy
  • Predictive Value of Tests
  • Practice Patterns, Physicians'
  • New York City