The first level fetal echographic examination is carry out by obstetrician or generic ultrasonographer who screen routinarely all normal and abnormal pregnacies.
All expectant women who present any conditions listed below must do a second level echocardiographic examination :
this is the high risk pregnacies for congenital heart diseases.

Before to list that I have the pleasure to publish this E-mail ( with the permission received from lady Tricia Christensen ) that extend the indications listed below for fetal echocardiography from the point of view of a mother

X-Envelope-Info: 
Date: Tue, 08 Jul 1997 18:13:11 -0800
From: Christensen 
Reply-To: allenc@sonic.net
mail to:
Subject: web pages

Dear Dr. Gerboni,

I wish to thank you for your wonderful and informative pages on fetal echocardiography. I have a beautiful year old son who was diagnosed prenatally at 17 weeks (by the wonderful Norman Silverman at UCSF) with dextro, pulmonary stenosis, ltga and a large VSD. Had my son's defects not been caught, his initial course could have been stormy indeed, as he appeared so well-looking and healthy when he was born (and we live 60 miles away from UCSF). So I am ever greatful that this diagnostic tool is an available and frequently accurate means of catching these defects.

Of late I have been thinking frequently about the "WHO" aspect of echos for pregnant women. My conclusion is that echos ought to be offered to any women who will not deliver in a hospital which does not have pediatric cardiologists. Most women do not even know of what an echo is unless they know something about heart defects (and that is pretty uncommon). Yet with the statistics of 8 in 1000 births, nearly 1%, there seems to be justification for at least offering this test, just as amnio, and fpt tests are routinely offered to women and frequently refused.

I realize that often less severe defects (and the common ones at that) don't warrant the emergency treatment that complex defects like my son's do. On the other hand, it seems shameful to lose a child because no one knew, or to make this process so much more difficult by having an blissfully expectant mother suddenly be faced with a critically ill child, a hospital transfer, etc etc, simply because the test is not offered.

..omissis

Tricia Christensen
Hearts for Hearts' Sake
http://www.geocities.com/hotsprings/5065/index.html

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Risk Factors for Fetal Heart Disease

• HISTORY OF CONGENITAL HEART DISEASE OR GENETICAL SYNDROME :

1. Self, child or relative with congenital heart disease
2. Precedent relative with cromosomal anomaly
3. Precedent child with cromosomal syndrome
4. Genetically trasmitted metabolic anomalies

• FETAL AND ABNORMAL PREGNANCY :

1. Intrauterine growth retardation
2. Abnormal extracardiac structure during first level echo
3. Abnormal amniotic fluid volume
4. Multiple gestation
5. Persistent malpresentation
6. Fetal cardiac arrhythmia
7. Incomplete or not diagnostic first level echo

• MATERNAL PREDISPOSING CONDITIONS :

1. Viral infections ( Rubella )
2. Diabetes
   ( pregestational insulin dependent, gestational )
3. Connective tissue disease (Lupus Eritematosus)
4. Isoimmunizzazione materno-fetale
5. Phenylketonuria
6. Advanced maternal age
7. Esposition to teratogens or drugs during the first trimester
   ( alcohol, oral contraceptives, phenytoin, lithium, antihypertensives, tocolytics; physical agents ie: radiations ).

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Important Remarks :

• A karyotypic abnormality may be present in 12-35 % of fetus with cardiac anomaly
• A cardiac anomaly may be present in 50-80% of fetus with karyotipic abnormality
• If extracardiac anatomy is abnormal, there is a 26 % chance that the heart is also abnormal

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Lingue

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©1995-2007 S.Gerboni

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SKYPE

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	S.I.C.P.
Societa' Italiana di Cardiologia Pediatrica

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	A.E.P.C.
Association for European Paediatric Cardiology

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