FETAL ECHOCARDIOGRAPHY - FACTORS THAT INFLUENCE IMAGING OF THE FETAL HEART DURING THE 2ND TRIMESTER OF PREGNANCY

Objective. The four-chamber view of the heart is an important componen t of the ultrasonographic examination of the fetus. However, during th e second trimester of pregnancy the fetal heart cannot always be image d in every patient. The purpose of this study was to ascertain the rat e of successful imaging of the fetal heart during the second trimester and to determine factors that may influence imaging. Methods. Seven h undred and nine second trimester fetuses were examined and an attempt was made to obtain the four-chamber and outflow tract views of the hea rt. Analysis included multiple logistic regression models of the main effects and interactions of ten candidate variables. Results. The four chambers and outflow tracts were imaged in 643 fetuses (90.7%) and no t imaged in 66 (9.3%). Fifty-two of 709 patients (7.3%) had had previo us surgery. In the 52 patients with a history of previous surgery, the heart could not be imaged in 18 (34%). Six hundred and fifty-seven pa tients (92.7%) did not have previous surgery. Of this group, the fetal heart could not be imaged in 48 (7.3%). In only one fetus in which th e heart could not be imaged was it because of fetal position. Three in dependent risk factors that influenced imaging of the fetal heart were gestational age, maternal adipose tissue thickness, and previous lowe r abdominal surgery. Increasing gestational age increased the probabil ity of imaging the heart, whereas increasing adipose tissue thickness and a history of previous surgery decreased the probability of imaging the heart, Comments. When the fetal heart cannot be imaged during the second trimester, these factors should be identified. Using data from this study, the gestational age at which the highest probability of i maging the heart can be determined if the thickness of the adipose tis sue and a history of lower abdominal surgery are known.