BACKGROUND: The ASE Council on Pediatric and Congenital Heart Disease has reviewed the literature and science and has found that as many as 1% of infants born in the United States have a heart defect, with 20%-30% of these babies suffering from serious or life-threatening defects. In fact, according to the Centers for Disease Control, congenital heart disease is the number one cause of infant death related to birth defects in the United States.

PRENATAL TESTING: Prenatal cardiac ultrasound allows identification of most types of congenital heart disease by the middle of pregnancy. However, physicians who do routine prenatal screening find less than 35% of these defects, leaving them to be discovered only after birth and, in many instances, not until the infant becomes profoundly ill. The International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) has recently issued new, expanded practice guidelines for screening of the fetal heart during the mid-pregnancy obstetric anatomy scan. In a recent evaluation of over 31,000 neonates and infants presenting between 2006 and 2012, obstetric scanning failed to detect 73% of patients with transposition of the great arteries and tetralogy of Fallot (both lesions which are easily seen when applying the new guidelines). Adoption of the new guidelines may dramatically increase not only screening efficacy, but also the number of referrals to specialized prenatal imaging facilities and centers that can provide appropriate life-saving care for these neonates.

EDUCATION: The gap in knowledge and practical application of these new guidelines is clear. Front-line ultrasound technicians and sonographers who work with radiology, obstetric, or maternal fetal medicine specialists and perform mid-pregnancy ultrasound screening exams are not usually asked to perform detailed cardiac screening views. Acquiring the necessary skills requires an investment of time and resources that may not be possible or readily available. The need for education shows remarkably little regional variation; all states in the United States are affected. But research has shown that with a rigorous population-based screening protocol that has at its core sonographer and clinician education, prenatal detection rates for serious disease can approach 90%.

OBJECTIVES: ASE, in support of the ASE’s Council on Pediatric and Congenital Heart Disease, proposes a concerted, cross-discipline, multi-organizational effort to provide teaching, resources, and accreditation in fetal cardiac screening. This effort should involve participation and collaboration by other stakeholders such as the American Institute of Ultrasound in Medicine, the Intersocietal Accreditation Commission, and the Society for Maternal Fetal Medicine. Guidelines for performance have been established and should be endorsed by these and other organizations.

Initiatives should include:

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  Development of course materials to train individuals in basic and advanced fetal heart screening.

  
  
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  Support for and/or development of conferences or symposia to facilitate training.

  
  
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  Development of guidelines for minimum standards of accreditation in fetal heart screening.

SUMMARY: The ASE will move to engage and coordinate these types of initiatives to further the adoption of the new ISUOG fetal heart screening guidelines to increase not only screening efficacy but also the number of referrals to specialized prenatal imaging facilities and centers that can provide appropriate life-saving care for neonates.