Fetal Echocardiography Audit in a Tertiary Hospital in Ibadan, Nigeria
Background: Delayed detection of congenital heart diseases in low- and middle-income countries (LMICs) contributes to the poor outcome of infants with cardiac anomalies. Fetal echocardiography (FE) can detect heart defects in-utero as early as the 18th gestational week (GA), giving parents and medical professionals time to prepare for the baby's delivery and appropriate treatment. University College Hospital, Nigeria, is one of the few centres in Nigeria where FE is performed.
Objectives: To examine the indications for referral for FE and the diagnoses made in our first four years of performing FE.
Methods: FE was performed in the antenatal clinic of the University College Hospital, Ibadan, Nigeria, using the GE Voluson P6 machine with a 2-6-RS probe. Demographic information was obtained from the antenatal clinic records of the women who had FE using a semi-structured questionnaire. FE diagnoses were retrieved from the FE register.
Results: A total of 129 women whose records were available were recruited for this study. The mean age of the women was 31.7±5.5 years. Forty-two women (32.6%) were referred because of echogenic foci, making this the most common indication for FE. Twenty-nine (22.5%) fetuses had structural heart defects, the most common being Ventricular Septal Defect.
Conclusion: There is a need for Obstetricians and Paediatricians to be aware of the indications for fetal echocardiography and refer women appropriately.
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392:1736–1788. https://doi.org/10.1016/S0140-6736(18)32203-7
Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Vol. 99, Medicine (United States). 2020. https://doi.org/10.1097/MD.0000000000020593
Gupta B, Antia AU. Incidence of Congenital Heart Disease in Nigerian Children. Br Heart J 1967;29:906–909. https://doi.org/10.1136/hrt.29.6.906
Ige O, Yilgwan CS, Bode-Thomas F, Ayatse F, Afolanranmi TO, Nkereuwem E, et al. Study of congenital heart defects among neonates in Jos, Nigeria: prevalence and spectrum. Cardiovasc J Afr 2021;32:21–27. https://doi.org/10.5830/CVJA-2020-044.
Gembruch U, Geipel A. Indications for fetal echocardiography: screening in low- and high-risk populations. In: Yagel S, Silverman NH, Gembruch U, editors. Fetal Cardiology. 2nd Ed. Florida: CRC Press. Taylor & Francis Group; 2009. p. 111–129.
Ekure EN, Sokunbi O, Kalu N, Olusegun-Joseph A, Kushimo O, Amadi C, et al. Congenital heart disease in school children in Lagos, Nigeria: Prevalence and the diagnostic gap. Am J Med Genet C Semin Med Genet 2020;184:47–52. https://doi.org/10.1002/ajmg.c.31779
Animasahun BA, Adekunle MO, Kusimo OY. Time to diagnosis, socioeconomic and clinical features of patients with congenital heart diseases in a teaching hospital in Nigeria. J Public Health Emerg. 2018;2:15–15. https://doi.org/10.21037/jphe.2018.04.01.
Ekure EN, Kalu N, Sokunbi OJ, Kruszka P, Olusegun-Joseph AD, Ikebudu D, et al. Clinical epidemiology of congenital heart disease in Nigerian children, 2012–2017. Birth Defects Res 2018;110:1233–1240. https://doi.org/10.1002/bdr2.1361
Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL. Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child 2016;101:516-520. https://doi.org/10.1136/archdischild-2014-307691.
Adebayo BE, Ogunkunle OO, Ayun FO. Meningitis presentation in a child with Tetralogy of Fallot. J Cardiol Cases 2016;13(3). https://doi.org/10.1016/j.jccase.2015.10.004
Holland BJ, Myers JA, Woods CR. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: A meta-analysis. Ultrasound Obstet Gynecol. 2015;45:631–638. https://doi.org/10.1002/uog.14882
Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease: A scientific statement from the American Heart Association. Circ. 2014;129:2183–2242. https://doi.org/10.1161/01.cir.0000437597.44550.5d
Pike JI, Krishnan A, Donofrio MT. Early fetal echocardiography: Congenital heart disease detection and diagnostic accuracy in the hands of an experienced fetal cardiology program. Prenat Diagn [Internet]. 2014;34:790–796. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pd.4372
Small M, Copel JA. Indications for fetal echocardiography. Vol. 25, Pediatric Cardiology. Springer, New York; 2004. p. 210–222.
Friedberg MK, Silverman NH. Changing indications for fetal echocardiography in a university centre population. Prenat Diagn 2004;24:781–786. https://doi.org/10.1002/pd.981
Sium AF, Abdosh AA, Gudu W. Fetal echocardiography in a low-income setting: relying on local maternal-fetal medicine experts for detection of fetal cardiac anomalies. Int J Gynaecol Obstet 2022; 161:412-416. https://doi.org/10.1002/ijgo.14633
Akinmoladun J, Ogbole G, Lawal T, Adesina O. Routine prenatal ultrasound anomaly screening program in a Nigerian university hospital: Redefining obstetrics practice in a developing African country. Niger Med J 2015;56:263-267. https://doi.org/10.4103/0300-1652.169705
Adebayo BE, Agaja OT. Awareness of fetal echocardiography and its indications among paediatricians in Nigeria. Prime Medics J 2019;2:19–26.
Cordes T, O'Leary P, Seward J, Hagler D. Distinguishing right from left: a standardised technique for fetal echocardiography. J Am Soc Echocadiogr 1994;7:47–53. https://doi.org/10.1016/S0894-7317(14)80417-3.
Agarwal A, Roen-Padilla S, Khemani J, Osmolovsky M, Amirtharaj C, Bhutada A, et al. Fetal echocardiography — A recent four-year experience from a single urban center. Prog Pediatr Cardiol 2016;43:95–97. https://doi.org/10.1016/j.ppedcard.2016.03.001
Prentice G, Welsh A, Howat A, Ross D, Henry A. Isolated ‘soft signs’ of fetal choroid plexus cysts or echogenic intracardiac focus – consequences of their continued reporting. Australas J Ultrasound Med 2019;22:253–264. https://doi.org/10.1002/ajum.12180.
Minnella GP, Crupano FM, Syngelaki A, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with increased nuchal translucency, tricuspid regurgitation and abnormal flow in ductus venosus. Ultrasound Obstet Gynecol 2020;55:637–644. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.21956.
Singh S, Jain M, Verma A, Jain D. Evaluation of nuchal translucency as a sonographic marker for screening congenital heart defects in high-risk cases. Int J Gynaecol Obstet 2019;3:160–162. Available from: https://doi.org/10.33545/gynae.2019.v3.i3c.277.
Sotiriadis A, Papatheodorou S, Eleftheriades M, Makrydimas G. Nuchal translucency and major congenital heart defects in fetuses with normal karyotype: a meta-analysis. Ultrasound Obstet Gynecol 2013;42:383-389. https://doi.org/10.1002/uog.12488.
Chiu G, Zhao A, Zhang B, Zhang T. Clinical value of isolated intracardiac echogenic focus in the fetal heart: A retrospective study in Chinese women. Clin Exp Obstet Gynecol. 2019;46(6):972–6. doi.org/10.12891/ceog5066.2019.
Boehme C, Fruitman D, Eckersley L, Low R, Bennett J, McBrien A, et al. The Diagnostic Yield of Fetal Echocardiography Indications in the Current Era. J Am Soc Echocardiogr 2022;35:217-227.e1. https://doi.org/10.1016/j.echo.2021.09.005
Azeez TA, Abo-Briggs T, Adeyanju AS. A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria. Indian J Endocrinol Metab 2021;25:182–190. https://doi.org/10.4103/ijem.ijem_301_21
Sun PF, Ding GC, Zhang MY, He SN, Gao Y, Wang JH. Prevalence of Congenital Heart Disease among Infants from 2012 to 2014 in Langfang, China. Chin Med J 2017;130:1069–1073. https://doi.org/10.4103/0366-6999.204923.
Boehme C, Fruitman D, Eckersley L, Low R, Bennett J, McBrien A et al. The Diagnostic Yield of Fetal Echocardiography Indications in the Current Era. J Am Soc Echocardiogr 2022;35:217-227.e1. https://doi.org/10.1016/J.ECHO.2021.09.005.
Varunashree ND, Shankar R, Navaneethan P, Kumar M, Benjamin SJ, Jacob SE, et al. Efficacy of Antenatal Ultrasound Examination in Diagnosis of Congenital Cardiac Anomalies in an Unselected Population: Retrospective Study from a Tertiary Centre. J Obstet Gynaecol India 2021;71:277–284. https://doi.org/10.1007/s13224-020-01424-3
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