Fetal Echocardiography : Do we Indians really need it? Dr. Murtaza Kamal

Congenital heart defects (CHD) have an incidence of 8/1000 live births. In India, 180,000 children are born with CHD every year. A significant proportion of infant mortality (10%) is attributed to CHD due to numerous shortcomings in the management and care provided to this group of babies. Echocardiography is the gold standard in the diagnosis of CHD in new-borns and the only diagnostic modality of CHD in the foetus.
With the advancement of knowledge and techniques of foetal ultrasound, foetal echocardiography has become an important investigation in developed nations. Diagnosis of CHD during foetal life not only identifies the heart lesion but may also lead to suspicion and detection of abnormalities with a syndromic association. It allows appropriate parental counselling about the disease condition, delivery planning, and immediate postnatal management to optimize the outcome.
However, whether foetal cardiac screening modifies neonatal outcomes remains unknown in the low‑.and middle‑income countries like ours. Reduced morbidity, following antenatal diagnosis, has been reported for various complex conditions in developed countries.
In India, foetal echocardiography is not widely available presently. Even in metro cities, only 1%–2% of pregnancies currently avail foetal echocardiography. In India, where <10% of neonates with critical cardiac lesions undergo timely detection and operative treatment, the impact of foetal echocardiography may be even more pronounced than those countries with active neonatal screening and referral services . Antenatal diagnosis of CHD will be associated with planned delivery at a tertiary centre with cardiac services leading to reduced mortality and morbidity, which is very much need of the hour.
In a recent study done at Mumbai at a tertiary care paediatric cardiology centre it was found that neonates diagnosed antenatally by foetal echocardiography presented to the hospital at an earlier age in a better condition as compared to those diagnosed after birth. There was an average delay of 4 days from the day of diagnosis to admission in the cardiac care centre in the 2nd group of babies.
Prenatal diagnosis helps in better understanding of CHD. It ensures that prenatal management if possible and delivery can be performed safely at a tertiary centre. In our country, delay in admission could be due to delay in diagnosis, referral, financial, and social hindrances. The time needed for acceptance of the condition by the parents, arrangement of funds, time needed for travel from a peripheral area to a tertiary level paediatric cardiology centre, further delays the presentation. In the absence of a strict new-born screening and limited echocardiogram availability, these children mostly present after the closure of life saving ductus arteriosus, resulting in hemodynamic instability and hence to unfavourable outcomes.
Foetal echocardiogram followed by thorough counselling can significantly improve outcomes. In the absence of new-born screening, limited availability of echocardiogram in NICUs and transport facility of a sick new born, antenatal diagnosis is the hour’s need. Early intrauterine referral and planned deliveries with multidisciplinary approach could ensure timely care to the new born, thereby reducing deaths during transport and preoperative stabilization in country like India.

Dr, Murtaza Kamal is presently working as a Diplomat of National Board Super Specialty (DNB-SS) resident in Pediatric Cardiology recognised by National Board of Examinations (NBE, New Delhi) at Star Hospital, Hyderabad, India.

Dr Murtaza Kamal, Resident DNB Super Speciality(Pediatric Cardiology), Star Hospitals, Banjara Hills Road-10

Vinod Kumar

Health Journalist & writer. Editor of monthly health magazine "Health Spectrum."

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