Journal of Ultrasound in Medicine, Vol 12, Issue 11 659-663, Copyright © 1993 by American Institute of Ultrasound in Medicine

JOURNAL ARTICLE

Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy

G. R. DeVore, A. L. Medearis, M. B. Bear, J. Horenstein and L. D. Platt
Genetics Institute Fetal Diagnostic Center, Pasadena, California.

OBJECTIVE. The four-chamber view of the heart is an important component of the ultrasonographic examination of the fetus. However, during the second trimester of pregnancy the fetal heart cannot always be imaged in every patient. The purpose of this study was to ascertain the rate of successful imaging of the fetal heart during the second trimester and to determine factors that may influence imaging. METHODS. Seven hundred and nine second trimester fetuses were examined and an attempt was made to obtain the four-chamber and outflow tract views of the heart. Analysis included multiple logistic regression models of the main effects and interactions of ten candidate variables. RESULTS. The four chambers and outflow tracts were imaged in 643 fetuses (90.7%) and not imaged in 66 (9.3%). Fifty-two of 709 patients (7.3%) had had previous surgery. In the 52 patients with a history of previous surgery, the heart could not be imaged in 18 (34%). Six hundred and fifty-seven patients (92.7%) did not have previous surgery. Of this group, the fetal heart could not be imaged in 48 (7.3%). In only one fetus in which the heart could not be imaged was it because of fetal position. Three independent risk factors that influenced imaging of the fetal heart were gestational age, maternal adipose tissue thickness, and previous lower abdominal surgery. Increasing gestational age increased the probability of imaging the heart, whereas increasing adipose tissue thickness and a history of previous surgery decreased the probability of imaging the heart. COMMENTS. When the fetal heart cannot be imaged during the second trimester, these factors should be identified. Using data from this study, the gestational age at which the highest probability of imaging the heart can be determined if the thickness of the adipose tissue and a history of lower abdominal surgery are known.

This article has been cited by other articles:

				M. O. Bahtiyar and J. A. Copel Improving Detection of Fetal Cardiac Anomalies: A Fetal Echocardiogram for Every Fetus? J. Ultrasound Med., December 1, 2007; 26(12): 1639 - 1641. [Full Text] [PDF]

				P. Jeanty, R. Chaoui, I. Tihonenko, and F. Grochal A Review of Findings in Fetal Cardiac Section Drawings: Part 1: The 4-Chamber View J. Ultrasound Med., November 1, 2007; 26(11): 1601 - 1610. [Abstract] [Full Text] [PDF]

				G. R. DeVore and B. Polanko Tomographic Ultrasound Imaging of the Fetal Heart: A New Technique for Identifying Normal and Abnormal Cardiac Anatomy J. Ultrasound Med., December 1, 2005; 24(12): 1685 - 1696. [Abstract] [Full Text] [PDF]

				I. Hendler, S. C. Blackwell, E. Bujold, M. C. Treadwell, P. Mittal, R. J. Sokol, and Y. Sorokin Suboptimal Second-Trimester Ultrasonographic Visualization of the Fetal Heart in Obese Women: Should We Repeat the Examination? J. Ultrasound Med., September 1, 2005; 24(9): 1205 - 1209. [Abstract] [Full Text] [PDF]

				J. S. KIRK, C. H. COMSTOCK, W. LEE, R. S. SMITH, T. W. RIGGS, and E. WEINHOUSE Fetal Cardiac Asymmetry: A Marker for Congenital Heart Disease Obstet. Gynecol., February 1, 1999; 93(2): 189 - 192. [Abstract] [Full Text] [PDF]