Avaliação da implementação de protocolo de estudo morfológico do coração fetal

Abstract

Introduction:The adequate evaluation of fetal heart anatomy by ultrasonography represents the opportunity for the identification of congenital heart diseases and allows adequate planning of perinatal care. Objectives: To evaluate the performance of the implementation of the fetal heart morphological evaluation protocol at the Maternidade Escola/UFRJ (ME/UFRJ), by determining the percentage of obtaining the screening plans of the protocol and the association of the success of the examination to the presence of overweight / obesity, diabetes and gestational age at the time of examination. Methods: Prospective, observational and analytical study. Pregnant women who underwent fetal heart morphological screening in the ME/UFRJ, from July 2014 to August 2015, were included. Maternal age, gestational age (GA), pre-gestational maternal body mass index (BMI), parity, presence of comorbidities and description of the plans of the fetal heart morphological evaluation protocol: 1) situscardiac, 2) cardiac rhythm check; 3) complete evaluation of the four chambers which includes: cardiac axis, absence of pericardial effusion, 4 present and proportional chambers, oval foramen leaflet opening to the left atrium (AE), drainage of pulmonary veins in AE, absence of wall hypertrophy ventricular; moderator band at the apex of the right Ventricle (RV), integrity of the interventricular septum; free opening of atrioventricular valves and insertion of valve leaflets; biventricular filling; 4) left ventricular outflow tract (LV); 5) transverse section of the plane of the three vessels (3VT); 7) anterograde flow in the ductal arch and transverse aortic, 8) aortic arch and 9) ductal arch. The screening exam was considered complete when all protocols were obtained; incomplete when failure to obtain any of the plans after two attempts 1 week apart and suspected when there was alteration in any of the plans established by the protocol. Results: 518 patients underwent a fetal heart morphological screening test. The variation found was: maternal age: 12 to 48 years; GA at the time of screening: 17 to 29 weeks; parity: 0 to 10; Pre-gestational BMI: 13.48 to 41.86 kg / m² and 248 patients had comorbidities. The plans were examined in the following proportions: cardiac situs, rhythm and 4 cardiac chambers: 100%; VD output: 97.55%; VE output: 98.05%; 3VT: 97.85; anterograde flow: 87.35%; aortic arch: 88.71% and ductal arch: 83.46%. The examination was complete in 76.64% of the cases. The association of gestational age and presence of overweight / obesity and diabetes with the success rate of the exam were significant in limiting the examination. Discussion:The effectiveness of the implementation of the fetal heart morphological evaluation protocol was evaluated. It is necessary to consider that the period studied represents the first year of incorporation of this test in the routine evaluation of the patients. Some tests were performed outside the ideal period of 20 to 24 weeks because the availability for marking was limited or for patients to present with advanced GA. Conclusions: Obtaining the screening plans was considered satisfactory. Overweight and pregestational obesity and gestational diabetes act as a hindrance to the morphological evaluation of the fetal heart.