Successful Fetal Tele-Echo at a Small Regional Hospital

Background:Prenatal diagnosis of complex congenital heart disease (CHD) has been shown to improve newborn outcomes. The rate of prenatal diagnosis and access to fetal echocardiography vary widely across the United States.Introduction:A clinical fetal tele-echo service was established at King's Daughters Medical Center (KDMC) in Ashland, KY, a region in eastern Kentucky that is 3h from the nearest congenital heart surgeon. The aim of this study was to determine if fetal tele-echo utilizing local sonographers at a small regional hospital can accurately and efficiently identify fetuses with complex CHD.Methods:Medical records were reviewed for all mother-infant pairs who had fetal tele-echoes performed at KDMC and interpreted by University of Louisville pediatric cardiology between March 2011 and December 2013. Findings on fetal tele-echo were compared to newborn echo and clinical course, and divided into four groups: (1) Correctno difference between fetal tele-echo and newborn echo, (2) Likely Correctnormal fetal tele-echo and benign newborn course, (3) Major Differenceone that affected newborn clinical course, and (4) Minor Differencedid not affect clinical course.Results:Seventy-five mother-infant pairs were analyzed. Fetal tele-echoes were Correct in 21%, Likely Correct in 56%, showed Major Differences in 0%, and showed Minor Differences in 23%. For identifying complex CHD, fetal tele-echo had a sensitivity and specificity of 100%. The average number of fetal echocardiograms per mother-infant pair was 1.1.Discussion:Fetal tele-echocardiography performed by local sonographers at a small regional hospital can accurately and efficiently identify fetuses with complex CHD.