Abstract 17104: Utility of Screening Fetal Echocardiogram Following Normal Anatomy Ultrasound for In Vitro Fertilization Pregnancies

Introduction: In-vitro fertilization (IVF) is associated with a higher incidence of congenital heart disease (CHD), resulting in universal screening fetal echocardiograms (F-echo) even when obstetric scan (OB-scan), including cardiac structures is normal. Recent studies suggest that when OB-scan is normal, F-echo may add little benefit and increases cost and anxiety. We aim to determine the utility of screening F-echo in IVF pregnancies with normal cardiac anatomy on prior OB-scan. Methods: We conducted a retrospective chart review of IVF pregnancies referred for F-echo at the Seattle Children’s Hospital between 2014 and 2020. OB-scan results and subspecialty of interpreting physician (Obstetrics=OB; Maternal Fetal Medicine=MFM; Radiology=Rads), F-echos, and postnatal outcomes were reviewed. Cardiac anatomy on OB-scans was classified as complete if 4-chamber and outflow-tract views were obtained. Supplemental views (three-vessel and sagittal aortic arch views) on OB-scan were also documented. Results: Of 525 IVF referrals, 450 had normal F-echo. OB-scan reports were available for review in 411; 304 (74%) demonstrated normal cardiac anatomy and were interpreted by OB (42%), MFM (61%) and Rads (31%). F-echo was normal in 270 (88%). Of the 34 abnormal F-echo, none required intervention (16 muscular and 5 perimembranous ventricular septal defects, 9 minor valve abnormalities, 2 mild ventricular hypertrophy, 2 arrhythmia). There was no difference in OB-scan accuracy for identifying normal cardiac anatomy when comparing 4-chamber and outflow-tract views vs. addition of supplemental views (88% vs 90% normal F-echo; p>0.1). Evaluation of OB-scan accuracy by interpreting physician subspecialty demonstrated normal F-echo in 93%, 80%, 91% read by OB, MFM and Rads, respectively. Conclusions: A majority of IVF referrals with normal cardiac anatomy visualized on OB-scan using 4-chamber and outflow-tract views resulted in normal F-echo, regardless of interpreting physician subspecialty or addition of supplemental views. Of the minority with abnormal F-echo, none required intervention. Consideration should be given to the cost/benefit of screening F-echo for the indication of IVF if normal cardiac anatomy is diagnosed on OB-scan.