THINK HEART

Headnote

Updating the 20/40 Fetal Cardiac Protocol.

Current NHS protocol recommends that all pregnant women in the UK are offered screening at between 18w and 2 0w 6d weeks' gestation. This is done by the way of an ultrasound examination to detect any fetal abnormalities that are incompatible with life; conditions whereby delivery in a specialist centre with rapid access to treatment may be critical for survival, or intervention during the gestational period is necessary1. The Fetal Anomaly Screening Programme (FASP) was established in 2001 to provide guidance for practitioners undertaking obstetric ultrasound, with a view to optimising the pre-natal detection rates of 11 auditable conditions, including congenital heart disease (CHD)2.

CHDs are one of the most common structural abnormalities and are responsible for approximately 43% of neonatal deaths annually3. In the UK, approximately 3 000 babies are born each year with a form of CHD and of these, 1000 babies are discharged home with an undetected abnormality4. In the majority of cases, the CHD will occur in a low-risk pregnancy, so a robust, standardised approach to the fetal cardiac assessment undertaken during the routine 20/40 obstetric ultrasound, is essential to increase the likelihood of pre-natal detection.

In 2010, FASP implemented a fetal cardiac screening protocol to standardise fetal cardiac assessment and ensure a thorough examination of the fetal heart was performed. In 2015, this protocol was updated to include the three vessel trachea (3VT) view, which is in the process of being introduced into obstetric departments.2.

The pre-natal detection target for CHD was initially set by FASP, and remains at 5 0% today, however, one study reported detection rates of up to 70% in geographical regions with a well-established specialist sonographer training programme in place5. This evidence suggests that access to training, and raised awareness of CHD in practitioners performing fetal cardiac assessment, is the key to improving the detection rate.

This article aims to improve the confidence of those undertaking fetal cardiac assessment by:

1) Renewing knowledge of fetal cardiac anatomy and pathology.

2) Reviewing the five sequential images required as part of the FASP protocol.

3) Re-enforcing scan techniques and competence in clinical skills.

In order to conduct a thorough assessment of the fetal heart, the practitioner must first have an understanding...