Connections: Prenatal detection of heart defects is key to outcomes | Summer 2019

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Explore more in the Summer 2019 issue of Connections

From the OHSU Doernbecher Children’s Hospital

Dr. Erin Madriago headshot

Erin Madriago, M.D.

Dr. Madriago is a pediatric cardiologist who has specialty training in imaging children’s hearts at all stages of life. She is the medical director of the Pediatric Echocardiography Laboratory and the Fetal Cardiology Programs at Doernbecher.

Finding a heart defect prenatally has tremendous benefits, such as reducing pre- and postoperative mortality, parental stress and transportation costs. Of the approximately 1,100 fetal echocardiograms we perform each year at Doernbecher, nearly one-third have an abnormal result.

With prenatal detection we can help families understand what the heart defect is, how it will affect their child and family, discuss future medical and surgical interventions, and develop comprehensive birth and follow-up plans.

When to prenatally screen for fetal heart defects

The chart below shows general risk factors for fetal congenital heart disease or CHD.

The ideal time to screen for most women is between 18-22 weeks of gestation: The fetal heart is well-formed but there is minimal bony shadowing. We can clear the heart of most critical issues at this point, however there are a few conditions that can develop later, or that we can’t see clearly until after birth. For example, while arrhythmias can happen at any point in pregnancy, certain cardiac tumors and progressive lesions (such as left- and right-sided obstructive disease), and other valvar disease, may not be apparent during this screening window.

We scan certain women earlier (starting at 16 weeks) because of risk factors. For example, if the mother is high-risk for CHD or has had a previous child with CHD, early screening helps not only with diagnosis but has been shown to reduce parental stress.

From screening to comprehensive planning

After a prenatal diagnosis is made, OHSU Doernbecher’s Fetal Cardiac Therapy Program provides a comprehensive care plan for families.

This prenatal program, the only one in the region, is comprised of a multidisciplinary team of maternal-fetal, pediatric and neonatal specialists with access to additional pediatric subspecialties and the most advanced technologies.

A pediatric cardiac nurse navigator coordinates patients’ care across a spectrum of medical and surgical specialties from prenatal diagnosis through the first year of life (Link Program).

The Link Team reaches out to the families pre- and postnatally and acts as an advocate for issues as they arise. This comprehensive approach to prenatal care, delivery planning and postnatal cardiac care supports the family through their journey.

When to refer

  • Pregnant women with a suspected or known fetal abnormality.
  • Pregnant women with hereditary risk factors that could affect the fetus.
  • Pregnancies involving more than one fetus.
  • Pregnancies with poor fetal growth.
  • Pregnant women with pregestational diabetes or maternal phenylketonuria syndrome.
  • Pregnant women with a history of lupus, Sjogren’s syndrome or diabetes.
  • Pregnancies resulting from in vitro fertilization.
  • Pregnancies with increased nuchal thickness.
  • Pregnant women on prescribed nonsteroidal anti-inflammatory drugs or ACE inhibitors.
  • Any cases where obtaining a clear scan of the heart is difficult, such as with obesity.

Contact us

OHSU Doernbecher Children’s Hospital specialists are always happy to speak with you.

Please call the OHSU Physician Pediatric Advice and Referral Service at 8883460644 with questions. To refer a patient, please fax to 5033466854.

High Risk (>2% RR)

  • 1st trimester rubella
  • CHD (mom, dad, sib)
  • Diabetes mellitus in first trimester
  • Extracardiovascular abnormality
  • Fetal arrhythmia
  • Fetal hydrops or effusion
  • Increased NT (>3 mm)
  • IVF
  • Karyotype abnormality
  • Maternal ACE-I, Retinoic acid, NSAIDS (3rd tri)
  • Maternal antibodies (SSA,SSB)
  • Maternal infection (suspicion of fetal myocarditis)
  • Maternal PKU
  • Mono twins
  • Pregestational diabetes mellitus
  • Suspected heart abnormality

Low Risk (1–2% RR)

  • Maternal anticonvulsants, Lithium, Vit A, Paroxetine, NSAIDS (2nd tri)
  • CHD in 2nd degree relative
  • Abnormal umbilical cord or placental flow
  • Fetal intra-abdominal venous anomaly

Not Indicated (<1% RR)

  • Gestational DM, HbA1c <6% in 2nd half of pregnancy
  • Maternal SSRI, Coumadin
  • Maternal infection other than Rubella
  • Isolated CHD in relative other than 1 or 2 degree

[Diagnosis and Treatment of Fetal Cardiac Disease: Scientific Statement from the AHA (Rychik et al, 2014)]