Rapid review
Early ultrasound detection of heart failure
Mapping review
|Updated
The Directorate of Health asked NOKC to assess first trimester ultrasound with measurements of nuchal translucency for the diagnosis of heart failure. NOKC published a health technology assessment report on ultrasound in pregnancy in 2008. This rapid review aimed to assess newer publications, primarily systematic reviews but also new primary studies.
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Key message
Methods
We searched for systematic reviews and HTA reports in CRD databases and Cochrane Library, new publications in Medline and EMBASE, and ongoing studies in the WHO database ICTRP during October−November 2010. We included studies that assessed the diagnostic performance of ultrasound in gestational week 11−14 for the diagnosis of congenital heart defects, the impact of the diagnosis on prognosis if the fetus as well as the impact on parents decisions and mental well being. Studies that assessed diagnosis of chromosomal abnormalities were excluded.
Results
Ultrasound screening with measurement of nuchal translucency in gestational week 11-14 has low detection rates, and discriminates poorly between healthy fetuses and fetuses with congenital heart defects. Screening in week 11−14 found fewer fetuses with CHD than studies in weeks 17−19, and most findings were false positives. The sensitivity was below 0.5 at both low threshold for nuchal translucency (≥ 3,0 mm or 95% percentile) and at higher threshold (≥ 3.5 mm or 99% percentile). Specificity was in the range of 0,92−1,0. Qualifications and experience were important for detection rates, both for the personnel undertaking the examinations and the experience of the center.
Close to half of all fetuses with congenital heart defects were detected by ultrasound screening in gestational week 17−19. The implication of this would be closer monitoring of the pregnant woman, planning the birth and possible interventions after birth.
We found no new systematic reviews or randomized controlled studies that assessed the prognostic impact of ultrasound screening with measurement of nuchal translucency in pregnancy week 11−14, nor any registered ongoing trials
Positive findings on ultrasound may increase maternal anxiety, and the when this disproved in later examinations the anxiety level remains higher in the rest of the pregnancy.
Induced abortions were slightly higher for women who were offered routine ultrasound.