ACCURACY OF ROUTINE ULTRASONOGRAPHY IN SCREENING HEART-DISEASE PRENATALLY

The aim of the present study was to assess the accuracy of the four-ch amber view as a screening test for detection of congenital heart disea se (CHD) prenatally in a low-risk population. A prospective observatio nal study was conducted in 17 ultrasound units of the Piemonte Region, Italy, in pregnancies with no risk factors for CHD. At each routine s can, from 18 weeks of gestational age, the four-chamber view of the he art was looked for. When an anomaly was suspected, the patients were r eferred to a specialized unit. Follow-up of the babies until discharge from the hospital was obtained. 11232 sonograms were performed on 829 9 pregnancies. Cardiac malformations were diagnosed in 40 newborns (4. 8/1000). Six of them (15 per cent) had been recognized in utero. The s ensitivity, specificity, and positive and negative predictive values w ere 15, 99.9, 50, and 99.6 per cent, respectively. When malformations that are not associated with an abnormal four-chamber view were exclud ed from the analysis, the sensitivity increased to 35.3 per cent. The sensitivity found in this study is low, but it is probably realistic s ince it is comparable to that reported in other multicentric studies. This type of study should reflect the state of the art of the method a pplied in the field. Although the sensitivity is low: it would be nil if the test were not performed. Moreover, it will probably increase wi th better training of the operators and by extending the examination t o the ventriculo-arterial connections. (C) 1997 by John Wiley & Sons, Ltd.