Referral Pattern for Fetal Echocardiography Over 10 Years in a Single Fetal Imaging Centre from Southern India

To study the trend in referral patterns for fetal echocardiography (FE) and the outcome Retrospective study of fetuses referred to a single fetal imaging center for FE from Jan 2008 to Dec 2017. The study group was divided into group 1 (2008–2012) and group 2 (2013–2017). Indications were categorized into ‘low-risk’, ‘maternal-risk’ and ‘fetal-risk’. Detection of cardiac defect (CHD) was noted as abnormal outcome and it was analysed in relation to the referral indication. The study group had 32,679 cases, 11,468 in group 1 and 21,211 in group 2. Total number of referrals showed an increase of 84% between first and second half of study. ‘Low-risk’ referrals were the most common in both groups but high risk referrals had shown an increase of 24.5% over years. Maternal diabetes was the most common ‘maternal-risk’ factor and abnormal cardiac finding in obstetric scan was the common ‘fetal-risk’ indication. Incidence of CHD increased from 4.6 to 10.2% during the study period. CHD was seen more in ‘fetal-risk’ indications (65%) compared to other risk groups (p < 0.05). Maternal-risk indications individually did not show a significant relationship to CHD. Abnormal cardiac findings in scan, extra-cardiac anomaly, aneuploidy screen positivity, single umbilical artery, growth and liquor abnormality showed a higher risk for CHD. Among low-risk 22.5% showed CHD. Referral of high-risk cases for FE has increased recently. Abnormal fetal findings in scan or screening tests was significantly associated with fetal CHD. A significant percentage of CHD was detected in the low-risk group. Strengthening fetal cardiac screening is needed to optimise appropriate risk stratification as well as to increase detection of cardiac anomalies.