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CHANGE IS IN THE AIR

Congenital heart disease is the most frequent congenital defect and accounts for significant morbidity and mortality. The responsibility to reduce this human suffering and the financial burden cannot be underestimated. This can be effectively achieved if we could reduce the incidence of congenital heart disease and fetal echocardiography sets out to do just that. It can change outcomes of babies who need heart disorder treatment by educating and training concerned medical personnel to diagnose them during fetal life and thereafter offer appropriate counsel and direction to families with management options.

FAQs about Fetal Echo

Q1: What is fetal echocardiography?

A: Fetal echo is a highly specialised form of prenatal scan where a detail evaluation of the heart is carried out. The entire structure (chambers, valves, blood vessels and partitions) can be visualised by this technique. The heartbeat and pumping efficacy is also assessed. This enables prenatal diagnosis of various forms of congenital heart defects & rhythm problems in the fetus.

Q2: What are the indications?

A: A basic heart scan should be compulsarily done as a part of every single obstetric USG.A detailed fetal echo should be advised where the scenario is as follows:

1. Family history of Congenital Heart Defects (CHD). The risk increases manifold especially if a sibling or either one of the parents have CHD.

2. Abnormal cardiac results from an obstetric ultrasound.

3. Any abnormality of another major organ system, abnormal fetal heart rhythm, chromosomal anomaly in fetus or Hydrops Fetalis.

4. Metabolic abnormality in mother e.g, Diabetes, Phenylketonuria, connective tissue disorders like SLE, any history of exposure to harmful medicines, toxins, radiations, intrauterine infections during pregnancy.

5. IVF pregnancy or intracytoplasmic sperm injection (ICSE) or twin pregnancy.

Q3. Are there any harmful effects?

A: No. It uses the common ultrasound principles and is very safe, even if it is performed multiple times in a single pregnancy.

Q4. When to perform ?

A: The ideal timing is in 18-24 weeks of pregnancy. Though nowadays early scans is offered in high risk pregnancy. Also, since the Indian MTP Act allows termination of pregnancy only till 20th week of gestation, it is preferred to conduct these scans before 20 weeks, so that if a major defect is identified the family can be offered all possible options.

Q5. What is the relevance of doing fetal echo in our setting?

A: Prenatal diagnosis improves the post-natal outcomes of infants with critical but correctable heart defects like Transposition of Great Arteries (TGA) or duct dependent conditions by timely in utero transport to a pediatric cardiac facility. Some forms of heart defects (like rhythm disorders) can be offered in utero treatment with excellent outcomes to the fetus.

Also if there is a complex CHD incompatible with normal life or which requires multiple high risk surgeries as part of the heart disorder treatment, parents can opt beforehand for discontinuation of the pregnancy, eventually decreasing the burden of CHD.

-Contributed by Dr Mily Ray,Consultant
– Pediatrics Cardiology, Max Super Speciality Hospital, Patparganj