Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
Abstract
Objectives
To report the normal fetal cardiac axis (CA) values at the time of the first trimester screening ultrasound.
Methods
Standardized images and measurement of the CA were obtained from 100 healthy fetuses between 11+0 and 13+6 weeks of gestation along with the nucal thichkness (NT), Crown–rump length (CRL) and other measurements. We excluded cases with abnormal NT, later diagnosis of abnormalities, and suspected fetal cardiopathy during the pregnancy follow-up. Data analysis was performed after all the patients delivered and cardiopathy was excluded.
Results
CA was measurable in all the cases. Higher CRL was associated with a decrease in the CA. The mean ± SD embryonic/fetal CA was 48±5,2°, ranging from 39 to 60°, The 2.5 percentile was defined at 40° and the 97.5 percentile at 59°. The Pearson test resulted in a significant correlation between CA and CRL with a coefficient R of 70% and p-value <0.01.
Conclusions
CA tends to decrease at the 11 to 13+6 gestational ages. We defined 2.5 and 97.5% curves for the normal values of CA in our Middle Eastern population. A larger study will be required to differentiate normal and abnormal values for the early detection of heart abnormalities.
Acknowledgments
We would like to thank Dr. Ghassan Sleilaty for his help in the statistical analysis of this study.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This study abides by the principles of the Helsinki Declaration and has been approved by the Ethics Committee of Saint Joseph University in Beirut and is registered as CEHDF-1132.
References
1. McFadyen, A, Gledhill, J, Whitlow, B, Economides, D. First trimester ultrasound screening. BMJ 1998;317:694–5. https://doi.org/10.1136/bmj.317.7160.694.Suche in Google Scholar PubMed PubMed Central
2. Economides, DL, Braithwaite, JM. First trimester ultrasonographic diagnosis of fetal structural abnormalities in a low risk population. Br J Obstet Gynaecol 1998;105:53–7. https://doi.org/10.1111/j.1471-0528.1998.tb09350.x.Suche in Google Scholar PubMed
3. Quarello, E, Lafouge, A, Fries, N, Salomon, LJ, the, CFEF. Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography. Ultrasound Obstet Gynecol 2017;49:224–30. https://doi.org/10.1002/uog.15866.Suche in Google Scholar PubMed
4. International Society of Ultrasound in Obstetrics and Gynecology null, Carvalho, JS, Allan, LD, Chaoui, R, Copel, JA, DeVore, GR, et al.. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013;41:348–59. https://doi.org/10.1002/uog.12403.Suche in Google Scholar PubMed
5. Christoffels, VM, Burch, JBE, Moorman, AFM. Architectural plan for the heart: early patterning and delineation of the chambers and the nodes. Trends Cardiovasc Med 2004;14:301–7. https://doi.org/10.1016/j.tcm.2004.09.002.Suche in Google Scholar PubMed
6. Carvalho, JS, Moscoso, G, Tekay, A, Campbell, S, Thilaganathan, B, Shinebourne, EA. Clinical impact of first and early second trimester fetal echocardiography on high risk pregnancies. Heart 2004;90:921–6. https://doi.org/10.1136/hrt.2003.015065.Suche in Google Scholar PubMed PubMed Central
7. Weerakkody, Y. Four chamber cardiac view (fetal) | Radiology Reference Article | Radiopaedia.org [Internet]. Radiopaedia. [cited 2020 Sep 5]. Available from: https://radiopaedia.org/articles/four-chamber-cardiac-view-fetal.Suche in Google Scholar
8. Filly, RA, Crane, JP. Routine obstetric sonography. J Ultrasound Med 2002;21:713–8. https://doi.org/10.7863/jum.2002.21.7.713.Suche in Google Scholar PubMed
9. Syngelaki, A, Chelemen, T, Dagklis, T, Allan, L, Nicolaides, KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenat Diagn 2011;31:90–102. https://doi.org/10.1002/pd.2642.Suche in Google Scholar PubMed
10. Achiron, R, Tadmor, O. Screening for fetal anomalies during the first trimester of pregnancy: transvaginal versus transabdominal sonography. Ultrasound Obstet Gynecol 1991;1:186–91. https://doi.org/10.1046/j.1469-0705.1991.01030186.x.Suche in Google Scholar PubMed
11. Hoffman, JI. The global burden of congenital heart disease. Cardiovasc J Afr 2013;24:141–5. https://doi.org/10.5830/cvja-2013-028.Suche in Google Scholar
12. Dolk, H, Loane, M, Garne, E. European Surveillance of Congenital Anomalies (EUROCAT) Working Group. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation 2011;123:841–9. https://doi.org/10.1161/circulationaha.110.958405.Suche in Google Scholar PubMed
13. Axt-Fliedner, R, Kreiselmaier, P, Schwarze, A, Krapp, M, Gembruch, U. Development of hypoplastic left heart syndrome after diagnosis of aortic stenosis in the first trimester by early echocardiography. Ultrasound Obstet Gynecol 2006;28:106–9. https://doi.org/10.1002/uog.2824.Suche in Google Scholar PubMed
14. Hutchinson, D, McBrien, A, Howley, L, Yamamoto, Y, Sekar, P, Motan, T, et al.. First-trimester fetal echocardiography: identification of cardiac structures for screening from 6 to 13 weeks’ gestational age. J Am Soc Echocardiogr 2017;30:763–72. https://doi.org/10.1016/j.echo.2017.03.017.Suche in Google Scholar PubMed
15. McBrien, A, Howley, L, Yamamoto, Y, Hutchinson, D, Hirose, A, Sekar, P, et al.. Changes in fetal cardiac axis between 8 and 15 weeks’ gestation. Ultrasound Obstet Gynecol 2013;42:653–8. https://doi.org/10.1002/uog.12478.Suche in Google Scholar PubMed
16. Jung, Y-J, Lee, B-R, Kim, GJ. Efficacy of fetal cardiac axis evaluation in the first trimester as a screening tool for congenital heart defect or aneuploidy. Obstet Gynecol Sci 2020;63:278–85. https://doi.org/10.5468/ogs.2020.63.3.278.Suche in Google Scholar PubMed PubMed Central
17. Sinkovskaya, E, Horton, S, Berkley, E, Cooper, JK, Indika, S, Abuhamad, A. Defining the fetal cardiac axis between 11 + 0 and 14 + 6 weeks of gestation: experience with 100 consecutive pregnancies [Internet]. Ultrasound Obstet Gynecol 2010;36:676–81. https://doi.org/10.1002/uog.8814.Suche in Google Scholar PubMed
18. Sinkovskaya, ES, Chaoui, R, Karl, K, Andreeva, E, Zhuchenko, L, Abuhamad, AZ. Fetal cardiac axis and congenital heart defects in early gestation. Obstet Gynecol 2015;125:453–60. https://doi.org/10.1097/aog.0000000000000608.Suche in Google Scholar PubMed
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds