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INTRODUCTION

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Definitions

  • 1. Cardiovascular profile score: a semiquantitative score of the fetal cardiac well-being which uses known markers by ultrasound that have been correlated with poor fetal outcome. The 5 categories are hydrops, venous and arterial Doppler, heart size, and abnormal myocardial function.

  • 2. Congenital heart disease: heart defects that have their origin during cardiac development from 4 to 8 weeks' gestation (conceptual age) and present after birth.

  • 3. Doppler echocardiography: a technique of physiology assessment in the fetus guided by ultrasonic imaging. The blood velocity at a selected site in the fetal circulation is sampled and displayed using color or velocity (pulsed Doppler sonography) display. Continuous wave Doppler sonography is used to assess high velocity jets in the fetal circulation such as tricuspid valve regurgitation.

  • 4. Dysrhythmia: any rhythm of the fetal heart that is abnormal and not associated with a regular atrial contraction followed by a ventricular contraction each cardiac cycle.

  • 5. Fetal congestive heart failure: a state of inadequate tissue perfusion in the fetal circulation. It manifests by reflexes triggered by sensors of cardiac flow in the fetal circulation and vital organs.

  • 6. Fetal echocardiography: a detailed ultrasonic examination of the fetal cardiac anatomy and physiology including assessment of the extracardiac vessels, including the peripheral arteries and veins. This is a test for definitive diagnosis of congenital heart disease and congestive heart failure in the fetus.

  • 6. Fetal heart screening: a brief sonographic examination of the fetal heart including 4-chamber view ("basic") and outflow tracts ("extended basic") assessment.

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The cardiovascular system provides a large volume of information about the well-being of the fetus. It is accessible because of rapid developments in the technology of noninvasive techniques, particularly ultrasonography. The fetus has become the new patient of the decade due to the rapid changes in ultrasonic technologies and other fetal assessment techniques. The fetal biophysical profile is useful to detect changes in fetal well-being, and assesses mainly changes in brain function.1,2 The decision to deliver a fetus prematurely due to cardiac changes must be made in the context of the risks both pre- and postnatally. Most associations of how cardiovascular changes correlate with other organ function in the fetus have yet to be defined. Therefore, any assessment demands a coordinated team approach between obstetricians, perinatologists, cardiologists, and neonatologists.3,4

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Cardiac defects are the most common cause of infant death in United States.5 They occur in approximately 0.8% of liveborn children, but in a much higher percentage of those aborted spontaneously, stillborn, or those diagnosed early in gestation.6 Although the etiology of heart defects is not known, population studies have suggested a number of factors that may increase the risk of heart defects. Approximately 8 in 1000 live births are affected by congenital heart disease. The incidence of severe congenital heart disease that will require heart surgery in the first year after birth is about 2.5 to 3 per ...

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