FETAL INDICATIONS

FETAL FACTOR

FETAL ECHOCARDIOGRAPHY IS INDICATED IF THERE IS:

1. Suspected Cardiac structural anomaly

2. Suspected abnormality in Cardiac function

Hydrops fetalis

3. Persistent Fetal Tarcycardia (heart rate > 180 beats per minute)

4. Persistent Fetal Bradycardia (heart rate < 120 beats per minute) or a suspected block

5. Frequent episodes or a persistently irregular cardiac rhythm

6. Major fetal extra cardiac anomaly

7. Nuchal translucency of 3.5mm or greater or at or above the 99th percentile for gestational age

8. Chromosomal abnormality by invasive genetic testing or with cell-free fetal DNA screening

9. Monochrionic twining

FETAL ECHOCARDIOGRAPHY MAY BE CONSIDERED IF THERE IS:

1. Systemic venous anomaly (eg, a persistent right umbilical vein, left superior vena cava, or absent ductus venous)

2. Greater-than-normal nuchal translucency measurement between 3.0 and 3.4 mm

3. In vitro fertilisation including intracytoplasmic sperm injection

4. Phenylketonuria (unknown status or a per-iconceptional phenylalanine level > 10mg/dl)

5. Autoimmune disease with antibodies and with a prior affected fetus

6. First-degree relative of a foetus with CHD (parents, siblings or prior pregnancy)

7. First- or second-degree relative with disease of Medelian inheritance and a history of childhood cardiac manifestations

8. Retinoid exposure

9. First-trimester Rubella infection

FETAL ECHOCARDIOGRAPHY MAY BE CONSIDERED IF THERE IS:

1. Selected teratogen exposure (eg, paroxetine, carbamazepine, or lithium)

2. Antihypertensive medication limited to angiotensincoverting enzyme inhibitors

3. Autoimmune disease with Sjogren Syndrome-related antigen A positivity and without a prior affected fetus

4. Second-degree relative of a fetus with CHD

Monochrionic Twins

Scope of Cardiac Assessment in Twins

Normal Function
Normal Heart Physiology
Detection of Structural Abnormality
Monitoring and FU of invasive procedure
Issues specific to twins

Specific to Monoch twins

Evaluate Twin to Twin Transfusion
Evaluate Cardiac Defects
Evaluate TRAP Sequesnce
Cardiac Pathology in conjoined Twins

Timing of Fetal Echo in Twins

Done at 18 weeks
Visualisation Optimal
Calcification does not help at 30 weeks
And fat/Oligohydramnios:
make exam less reliable
inaccurate
time consuming difficult

TWIN TO TWIN TRANSFUSION SYNDROME (TTTS)

Only in Monochorionic Diamniotic Twins
In 1/3 of all Monozygotic twins
15-20% of all Monochorionic Diamniotic twins have unbalanced blood flow

Twin to Twin Transfusion

MonoCh Twins: routine echo at 18 weeks if concordant growth
If growth discordant: echo to be performed at that stage
TTTS results from unbalanced circulation from the same set of twins
Hypervolemia in recipient and hypovolemia in donor

Delhi Fetal Heart Center

THE CENTER WITH THE LARGEST FETAL CARDIOLOGY EXPERIENCE Fetal Echo

FETAL INDICATIONS

FETAL FACTOR

Monochrionic Twins

Delhi Fetal Heart Center

THE CENTER WITH THE LARGEST FETAL CARDIOLOGY EXPERIENCE Fetal Echo

FETAL INDICATIONS

FETAL FACTOR

Monochrionic Twins

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