Detection of fetal cardiac anomalies in diabetic mothers: The utility of fetal echocardiography

FETAL ECHOCARDIOGRAPHY SCOTT PETERSEN, MICHAEL PITT, JANICE HENDERSON, JUDE CRINO, Johns Hopkins University, OBGYN/MFM, Baltimore, Maryland, Johns Hopkins University, School of Medicine, Baltimore, Maryland OBJECTIVE: Infants of diabetic mothers are more likely to have congenital cardiac malformations than the general population. In our institution, we obtain a four-chamber view (4CH) as well as outflow tracts (LVOT, RVOT) on all fetuses and refer pre-gestational diabetics for a fetal echocardiogram. The objective of this study was to determine the utility of a fetal echocardiogram after a normal anomaly scan. STUDY DESIGN: Pre-gestational diabetic mothers were identified who had undergone screening ultrasound and fetal echocardiography at our hospital during the last four years. A retrospective review of maternal records was conducted to obtain these study results. Neonatal records were reviewed, when available, for confirmation of antenatal findings. RESULTS: One hundren and eighty-one patients had both a sonographic 3view evaluation of the heart (4CH, LVOT, RVOT) and a fetal echocardiogram attempted, of which 146 had both completed. In this subgroup, eleven neonates (n = 67) were identified with abnormal postnatal echocardiograms. Four had clinically relevant cardiac disease which we defined as the need for surgical or medical intervention. The sensitivity for detecting clinically relevant disease was 75% (NPV 98.4%) for both sonographic methods (a VSD requiring surgical correction was not detected by either method). One fetus with a normal 3-view evaluation was found to have pulmonary stenosis with mild pulmonary and tricuspid regurgitation by fetal echocardiogram. These findings were confirmed in the neonatal period, but the child has had an uncomplicated clinical course. CONCLUSION: In our pre-gestational diabetic population, 3-view screening of the heart and fetal echocardiography have similar detection rates for cardiac anomalies. Given the high cost and limited availability of fetal echocardiography, 3-view screening alone may identify the majority of clinically important cardiac lesions. Fetal echocardiography may be reserved for suspected cardiac anomalies on a screening sonogram or patients with an incomplete study. 624 MAGNETIC RESONANCE IMAGING OF THE CERVIX DURING PREGNANCY: EFFECT OF GESTATIONAL AGE AND PRIOR VAGINAL BIRTH MICHAEL HOUSE, MARK O’CALLAGHAN, JONATHAN KINI, DANNY WU, SAMUEL PATZ, STEPHANE BAHRAMI, RAFEEQUE BHADELIA, Tufts-New England Medical Center, Maternal Fetal Medicine, Boston, Massachusetts, Tufts-New England Medical Center, Radiology, Boston, Massachusetts OBJECTIVE: To investigate how gestational age and prior vaginal birth affect cervical anatomy on MR imaging during pregnancy. STUDY DESIGN: In 56 consecutive pregnant patients referred to MRI for a suspected fetal or placental abnormality, high-resolution images of the cervix were obtained. A 1.5 Tesla system was used with a phased array surface coil. A proton density pulse sequence was chosen (TR 9900 ms, TE 10 ms). MRI image measurement was performed using a standardized image processing protocol. The following outcome variables were measured: (1) signal intensity of the cervical stroma (normalized to the signal intensity of the bladder contents); (2) cross-sectional area of the cervical canal and cervical stroma; and (3) angle of the cervix with respect to the uterus. Gestational age and obstetric history were recorded. Regression was used to determine whether the outcome variables were affected by gestational age or prior vaginal birth. RESULTS: Adequate images were obtained in 53 of 57 patients, at gestational ages 17–36 weeks. 1. Decreased contrast between the cervical stroma and the bladder was observed with increasing gestational age, reflecting increased stroma hydration. For example, the mean relative signal intensity at 20 weeks gestation was 0.84 (95% confidence interval [CI] 0.81–0.86). The mean relative signal intensity at 32 weeks was 0.92 (95% CI 0.88–0.95), a 10% increase compared to 20 weeks. 2. As gestational age increased 12 weeks, the mean cross-sectional area of the cervical canal and cervical stroma increased 31% (95% CI 0-73) and 31% (95% CI 11-55), respectively. 3. The mean anterior angle of the cervical canal was greater than the posterior angle (127 vs 95 degrees, P ! .001) and did not vary with gestational age. None of the outcome variables were affected by prior vaginal birth. CONCLUSION: MR imaging of the cervix demonstrated that increasing gestational age was associated with increased cross-sectional area and increased stroma hydration. Prior vaginal birth did not affect cervical anatomy on MR imaging.