Feasibility of fetal echocardiography screening during first trimester in a low-risk population


  • Ambika Perumal Sudha Hospitals, Coimbatore, Tamil Nadu, India
  • Lalitha Natarajan Department of Obstetrics and Gynecology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • Reena Abraham Department of Obstetrics and Gynecology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India




Congenital heart disease, Fetal echocardiography, First trimester, Feasibility, Low risk, Infants


Background: Prenatal identification of cardiac defect gives families the opportunity to receive counselling regarding the anticipated fetal and neonatal outcomes. Screening and diagnosis of congenital heart disease in the first trimester has increased over the past decade as almost all CHDs are already established by that time. Objective was to assess the feasibility of screening through first trimester echocardiography by a trained observer in low-risk populations.

Methods: The study was conducted on a sample of 500 antenatal mothers of gestational age between 11-13 weeks+6 days attending a teaching hospital. Maternal age, weight, height, body mass index, parity, gestational age, obstetric history and past history were recorded. In addition to first trimester ultrasound screening for aneuploidy in foetuses, a simplified echocardiographic examination was performed. After obtaining the appropriate fetal position, Crown-rump length was documented. Nuchal translucency thickness was recorded. After examination with 2-dimensional sonography, the operator obtained the tricuspid flow and ductus venosus flow. Color flow mapping was applied for evaluating the 4-chamber view and three vessel tracheal views. Specific criteria developed for the 4-chamber view, 3 vessel trachea view, tricuspid flow and ductus venosus flow was used to assess feasibility.

Results: Good feasibility was observed for all the views, with tricuspid flow showing 96% feasibility, Ductus Venosus showing 95% feasibility, 3VT view showing 90.1% feasibility and 4CV view having 89.7% feasibility. There was no significant association found between maternal BMI, CRL and the feasibility of fetal cardiac screening.

Conclusions: Encouraging results of this study indicates the feasibility of fetal cardiac screening in low-risk population.


Bouma BJ, Mulder BJ. Changing Landscape of Congenital Heart Disease. Circ Res. 2017;120(6):908-22.

Meller CH, Grinenco S, Aiello H, Córdoba A, Sáenz-Tejeira MM, Marantz P, et al. Congenital heart disease, prenatal diagnosis and management. Arch Argent Pediatr. 2020;118(2):e149-61.

Bakker MK, Bergman JEH, Krikov S, Amar E, Cocchi G, Cragan J, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ. 2019;9(7):e028139.

Ye B, Wu Y, Chen J, Yang Y, Niu J, Wang H, et al. The diagnostic value of the early extended fetal heart examination at 13 to 14 weeks gestational age in a high-risk population. Transl Pediatr. 2021;10(11): 2907-20.

Hernandez-Andrade E, Patwardhan M, Cruz-Lemini M, Luewan S. Early evaluation of the fetal heart. Fetal Diagn Ther. 2017;42:161-73.

Liu Y, Chen S, Zühlke L, Black GC, Choy MK, Li N, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019; 48(2):455-63.

Wiechec M, Knafel A, Nocun A. Prenatal detection of congenital heart defects at the 11- to 13-week scan using a simple color Doppler protocol including the 4-chamber and 3-vessel and trachea views. J Ultrasound Med Am Inst Ultrasound Med. 2015;34(4):585-94.

Patel N, Narasimhan E, Kennedy A. Fetal Cardiac US: Techniques and normal anatomy correlated with adult CT and MR Imaging. Radiographics. 2017;37(4): 1290-303.

Quarello E, Lafouge A, Fries N, Salomon LJ. Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography. Ultrasound Obstet Gynecol. 2017;49(2):224-30.

Sun HY. Prenatal diagnosis of congenital heart defects: echocardiography. Transl Pediatr. 2021;10(8):2210-24.

Kashyap N, Pradhan M, Singh N, Yadav S. Early detection of fetal malformation, a long distance yet to cover! present status and potential of first trimester ultrasonography in detection of fetal congenital malformation in a developing country: experience at a tertiary care centre in India. J Pregnancy. 2015; 2015:623059.

AIUM Practice Parameter for the Performance of Fetal Echocardiography. J Ultrasound Med. 2020;39(1):E5-16.

Hutchinson D, McBrien A, Howley L, Yamamoto Y, Sekar P, Motan T, et al. First-Trimester Fetal Echocardiography: Identification of Cardiac Structures for Screening from 6 to 13 Weeks' Gestational Age. J Am Soc Echocardiogr. 2017;30(8):763-72.

Scala C, Morlando M, Familiari A, Leone Roberti Maggiore U, Ferrero S, et al. Fetal Tricuspid Regurgitation in the First Trimester as a Screening Marker for Congenital Heart Defects: Systematic Review and Meta-Analysis. Fetal Diagn Ther. 2017;42(1):1-8.

Karadzov ON, Egic A, Damnjanovic-Pazin B, Lukic R, Joksic I, Mikovic Z. Screening performance of congenital heart defects in first trimester using simple cardiac scan, nuchal translucency, abnormal ductus venosus blood flow and tricuspid regurgitation. Congenit Heart Dis. 2019;14(6):1094-101.

Wagner P, Eberle K, Sonek J, Berg C, Gembruch U, Hoopmann M, et al. First-trimester ductus venosus velocity ratio as a marker of major cardiac defects. Ultrasound Obstet Gynecol. 2019;53(5):663-8.

Wiechec M, Knafel A, Nocun A. Prenatal detection of congenital heart defects at the 11- to 13-week scan using a simple color Doppler protocol including the 4-chamber and 3-vessel and trachea views. J Ultrasound Med. 2015;34(4):585-94.

Fratto VM, Chang A, Anton T, Sun HY, Lamale-Smith LM, Pretorius DH. Detailed Fetal Anatomic Ultrasound Examination: Effect of the 2014 Consensus Report on a Tertiary Referral Center. Ultrasound. 2019;35(1):21-9.

Kamel H, Yehia A. First trimester fetal echocardiography limitations and its expected clinical values. Egypt Heart J. 2020;72(1):16.

Ruiz A, Cruz-Lemini M, Masoller N, Sanz-Cortés M, Ferrer Q, Ribera I, et al. Longitudinal changes in fetal biometry and cerebroplacental hemodynamics in fetuses with congenital heart disease. Ultrasound Obstet Gynecol. 2017;49(3):379-86.

Li Y, Feng T, Sun J. Evaluation of clinical effect of transabdominal sonography and transvaginal sonography in early diagnosis of ectopic gestation. Pak J Med Sci. 2017;33(1):53-8.

García DR, García RR, Ortega CI, González MJM, De Luis AM, Segura GJ, et al. Feasibility and accuracy of early fetal echocardiography performed at 13+0-13+6 weeks in a population with low and high body mass index: a prospective study. Reprod Sci. 2021;28(8): 2270-7.

Toscano M, Grace D, Pressman EK, Thornburg LL. Does transvaginal ultrasound at 13-15 weeks improve anatomic survey completion rates in obese gravidas? J Matern Fetal Neonat Med. 2021;34(5):803-9.

Nemescu D, Onofriescu M. Factors affecting the feasibility of routine first-trimester fetal echocardiography. J Ultrasound Med. 2015;34(1):161-6.

D'Amelio R, Giorlandino C, Masala L, Garofalo M, Martinelli M, Anelli G, et al. Fetal echocardiography using transvaginal and transabdominal probes during the first period of pregnancy: a comparative study. Prenat Diagn. 1991;11(2):69-75.

Vimpelli T, Huhtala H, Acharya G. Fetal echocardiography during routine first-trimester screening: a feasibility study in an unselected population. Prenat Diagn. 2006;26(5):475-82.

Lombardi CM, Bellotti M, Fesslova V, Cappellini A. Fetal echocardiography at the time of the nuchal translucency scan. Ultrasound Obstet Gynecol. 2007; 29(3):249-57.

Abu-Rustum RS, Ziade MF, Abu-Rustum SE. Learning curve and factors influencing the feasibility of performing fetal echocardiography at the time of the first-trimester scan. J Ultrasound Med. 2011;30(5): 695-700.






Original Research Articles