ANTENATAL ECHOCARDIOGRAPHIC SCREENING: AN OVERRATED ROUTINE PRACTICE IN ASYMPTOMATIC MOTHERS

Abstract

Background: Echocardiographic evaluation is conducted as a part of routine antenatal screening in
India. We conducted a study to evaluate if routine echocardiographic screening in asymptomatic
patients with no self-reported symptoms and no abnormalities on clinical examination would alter the
intrapartum and peripartum care. A single centre retrospective review of case records and
echocardiographic images of 472 asymptomatic patients, conducted as a part of routine antenatal
screening were reviewed by 2 independent cardiologists. The study excluded pregnant patients with
known cardiovascular diseases (CVD) and those with clinical risk factors.
Results: The rate of newly diagnosed CVD in the study was 3.6%. Acquired heart disease was found in
2.7% of the study population which comprised Rheumatic heart disease (RHD) in 0.42%, mitral valve
prolapse (MVP) without mitral regurgitation (MR) in 0.84%, and MVP with MR in 1.48%. Congenital
heart disease (CHD) was incidentally detected in 0.84% of patients comprising atrial septal defect
(ASD), patent foramen ovale (PFO), a bicuspid aortic valve respectively, and prominent coronary sinus
and persistent left superior vena cava (PLSVC). None of the patients required changes in the preexisting treatment plan, and none were recommended for termination of pregnancy or change in the
mode of delivery.
Conclusions: Echocardiographic evaluation of asymptomatic antenatal mothers is clinically unjustified.
If CVD is diagnosed in asymptomatic mothers, it would primarily belong to the low-risk category and
would not contribute to the intrapartum or peripartum care plan in any form but add to the economic
burden compromising other essential antenatal care services.