Spring 2010

Early Fetal Echo Improves Patient Options

Anita Moon-Grady, M.D."Fetal echocardiography, done as early as 12 to 14 weeks into pregnancy, can now accurately identify heart structures and function — and uncover heart disease," says Anita Moon-Grady, M.D., director of the Fetal Cardiovascular Program at UCSF Benioff Children's Hospital. "The combination of accumulated experience with advances, such as high-frequency transducers and improvements in imaging technology, makes these early fetal echo scans an important option."

Identifying potential problems early allows health care providers to follow at-risk pregnancies more closely, gives families more time to consider treatment choices, and can help health care teams better manage the pregnancy and lessen the risks of potential procedures. With many obstetrician-gynecologists performing nuchal translucency scans earlier in the pregnancy, follow-up with early fetal echo also can help reassure patients that abnormal findings are being addressed.

Anita Moon-Grady, M.D.The UCSF program, which has been providing early fetal echocardiography as a regular service since 2004, recently completed a study of more than 100 pregnant women who had both early fetal echos and mid-second trimester scans. The study found that the early procedure could accurately diagnose fetuses with heart disease and identify normal structure and function almost as completely as an 18- to 22-week echocardiogram — with no significant corresponding errors. Moon-Grady presented the results of the study at the March meeting of the American Institute of Ultrasound in Medicine.

Early Diagnosis and Coordinated Care Can
Improve Outcomes

A multidisciplinary program also enhances the various treatment options. For example, when physicians identify fetal cardiac disease early, the UCSF Fetal Cardiovascular Program, which is closely affiliated with the UCSF Fetal Treatment Center and Pediatric Heart Center, offers fully coordinated care drawn from a team of experts that includes:

  • obstetricians
  • maternal-fetal specialists
  • pediatric cardiologists
  • pediatric cardiothoracic surgeons
  • social workers
  • financial counselors
  • geneticists and genetic counselors

Care begins with a complete evaluation of both mother and fetus, after which physicians counsel the parents about treatment options and likely long-term outcomes for the infant. "We then develop a detailed follow-up plan and help coordinate care with the referring provider for the remainder of the pregnancy," says Moon-Grady.

If fetal cardiac intervention is necessary, UCSF is the only center on the West Coast to offer fetal interventional procedures for aortic stenosis, pulmonary stenosis and restrictive atrial septum. For postnatal surgery or catheterization, experts from the UCSF Pediatric Heart Center can perform the procedures at UCSF Benioff Children's Hospital, coordinating with local resources and pediatric and neonatal care providers.

Clinical Indicators for First Trimester Fetal Echocardiography Referral

  • Abnormal nuchal translucency screening result (chromosome problem, cardiac defect or a combination of both)
  • Any other suspected cardiac abnormality on first trimester imaging
  • Family history of heart disease
  • Prior affected pregnancy
  • Pregestational diabetes
  • Teratogen exposure
  • Multiple gestations, especially monochorionic twins
  • Assisted reproduction, including IVF

"In addition, we can track and help coordinate delivery and postnatal care for babies who will need more routine cardiac surgery early in life, but who do not necessarily need to be delivered at UCSF," says Moon-Grady.

For more information, contact the Fetal Cardiovascular Program at (415) 353–1887 or the Pediatric Heart Center at (415) 353–2008.

 

Spring 2010 Table of Contents

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Related Information

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Childhood Obesity Interventions Must Begin Early
In a Perspective piece that appears in the April 22, 2010, issue of the New England Journal of Medicine, two UCSF experts assert that optimizing First Lady Michelle Obama's "Let's Move" obesity prevention program requires targeting pregnant women, infants and toddlers.

Clinical Trial Recruits Children to Test Type 1 Diabetes Drug
UCSF Benioff Children's Hospital is one of 10 centers nationwide recruiting patients age 12 to 17 for a clinical trial aimed at resolving type 1 diabetes. The project is studying whether the drug Thymoglobulin can delay — or permanently stop — a malfunctioning immune system's attack on insulin-producing cells in the pancreas.

Farmer Inducted into Royal College of Surgeons
On January 20, 2010, UCSF Benioff Children's Hospital Surgeon in Chief Diana Farmer, M.D., was inducted as a fellow into the Royal College of Surgeons of England.