The antenatal diagnosis of congenital heart disease using fetal echocardiography: is color flow mapping necessary?

Article Abstract:

Echocardiography is a diagnostic imaging technique that uses ultrasound to examine the heart. For many years, it has been used to detect congenital heart disease in fetuses. Many improvements in technique have enhanced the ability to detect fetal heart abnormalities with echocardiography. A recent innovation in technique is Doppler color flow mapping, which adds colored information regarding blood flow to the gray images that define heart structure. It has been increasingly used for fetal examination despite increased cost. This study evaluated whether the information obtained using color flow mapping was substantially greater than standard echocardiography to justify the extra costs involved. Echocardiograms and color flow mapping obtained from fetal examinations over a one-year period were reviewed. The color mapping had been performed on fetuses that appeared to have abnormalities on plain echocardiography. A total of 854 echocardiograms were performed on 776 fetuses, of which 48 had suspected cardiac abnormalities. Color mapping was performed on 45 of these 48 fetuses. Final evaluation of the abnormalities was made after birth. Color mapping provided essential information for 13 fetuses, helpful information for 21 fetuses, and no additional information for 11 fetuses. It was more helpful when the abnormality involved the great vessels of the heart. These results indicate that although color flow mapping is helpful in further defining fetal heart abnormalities, its use is not appropriate in settings designed only to screen fetuses for congenital heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Congenital heart disease, Congenital heart defects, Echocardiography, Doppler echocardiography

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Integrated screening for Down's syndrome based on tests performed during the first and second trimesters

Article Abstract:

An integrated screening program for Down syndrome appears to be very effective in detecting this condition with a very low false-positive rate. The program involves blood tests and ultrasound imaging during the first trimester, and blood measurements of alpha-fetoprotein, estriol, chorionic gonadotropin and inhibin during the second trimester. In a study of over 95,000 pregnancies, the integrated screening program detected 85% of the fetuses affected by Down syndrome with a 0.9% false-positive rate. To achieve such a high detection rate, current screening programs would have false-positive rates as high as 22%.

Statistical Data Included, Innovations, Medical screening, Health screening

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Prenatal screening for Down's syndrome -- a search for the family's values

Article Abstract:

What type of screening test is done to detect Down syndrome is dependent on the family's wishes. Some tests are done in the first trimester when abortion is easier. However, these tests are not as accurate and there may be a high false-positive rate. Others are done in the second trimester and are more accurate. But a woman might not want to abort the fetus at that late stage. Some tests are more expensive than others. A 1999 study found that using both first-trimester and second-trimester tests increased the accuracy and lowered the false-positive rate.

Editorial, Analysis, Prenatal diagnosis

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