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Foetal heart abnormalities: better anticipation for better support

Knowing the exact condition of the foetal heart is an essential requirement

The Clinique des Grangettes organises an annual training course for physicians. In this context, the conference devoted to “foetal heart screening in the second trimester” brought together some sixty healthcare professionals: proof of the importance of this subject! Ultrasound in the second trimester of pregnancy, in the absence of history, is indeed a time to detect major congenital heart diseases (cardiac defects occurring during formation over the intrauterine life).

The statistics are there to confirm this observation: in a foetal ultrasound reference centre, nearly 90% of cases of congenital heart disease are detected in the second trimester of pregnancy. “However, note that a small number of heart defects appear only in late pregnancy or after birth,” said Dr. Christian Bisch, specialist in prenatal ultrasound at the Dianecho centre of the Clinique des Grangettes. Sometimes, foetal cardiopathy may also be suspected in the ultrasound examination of the first trimester and can then be confirmed from the fourth month of pregnancy. In any case, any doubt about congenital heart disease is raised after a further analysis of foetal ultrasounds by a reference centre or specialist pediatric cardiologist. A thorough morphological assessment of the foetus is then performed and amniocentesis offered to prospective parents because some heart diseases may be associated with other malformations and chromosomal or genetic abnormalities. In any event, the advice of a specialist in foetal echocardiography remains important in defining the treatment options.

Dr. Cécile Tissot, a specialist in paediatric cardiology, said here that, in general, “the anomaly does not pose a problem during pregnancy because foetal circulation is very different from the post-natal period, given the role of oxygenation of the placenta. In the vast majority of cases, we wait until after birth, both from a medical and surgical standpoint.” For Dr. Cécile Tissot: “Many defects do not prevent the development of the foetus. However, during birth, the child must perform its own oxygenation. This is where defects are manifested and some will require the immediate infusion of a molecule called prostaglandin, which is essential for survival in some specific situations.
In addition, the paediatric-cardiologist may be required to perform cardiac catheterisation immediately after birth.” To prevent the sudden death of young patients after childbirth, anticipation therefore remains the top priority. And to forestall difficulties, knowing the exact condition of the foetal heart is an essential requirement.

Currently, there is an international standardisation of the ultrasound examination of the foetal heart: this change, in line with the continuing education of doctors, explains the increased rate of congenital heart disease screening. For Dr. Christian Bisch, “improving the quality of prenatal ultrasound images and the new tools available to specialists will further facilitate the examination of the foetal heart and improve the training of physicians.”

 

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