Fetal tele-echocardiography may be appropriate during pandemic
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Fetal echocardiograms for low-risk pregnancies have been reduced during the COVID-19 pandemic, which may bring about a need for fetal tele-echocardiography, according to a review published in Progress in Pediatric Cardiology.
Such an approach could allow pediatric cardiologists to review fetal echocardiograms without coming in contact with the patient and minimizing contact with other medical professionals, according to the authors.
“We know that fetal diagnosis of critical congenital heart disease is key to best postnatal outcomes,” Shubhika Srivastava, MD, chief of cardiology at Nemours Children’s Health System in Delaware, told Healio. “The review focused on assessment of indications for which fetal echo was used in the identification of birth defects. Secondary to evolving regulations for personal protective equipment and social distancing, much of the availability of fetal echos was restricted to indications that had a high yield for congenital heart disease. This could have led to some patients presenting very sick postnatally who could have been diagnosed in utero.”
According to the review, in keeping with changes to guidelines, during the pandemic, screening for congenital heart disease via fetal echocardiography by pediatric cardiologists has been restricted in patients with a 3% risk or lower.
“Education and care may be further enhanced with fetal tele-echocardiography, or the ability to guide obstetrical sonographers through a complete evaluation remotely, in conjunction with a telehealth consult with the family,” the authors wrote. “The telehealth consult may be scheduled with a pediatric cardiologist and a congenital heart surgeon. Telehealth consultations, while not allowing the physicians to be directly present with a family during a stressful time, may become a new norm during a time of risk to patients and health care providers.”
In an interview, Srivastava said: “The most important impact of this has been recognition of the need for increased awareness of indications for fetal echocardiogram and the education and skills of obstetric sonographers who perform the initial anatomy scan at the obstetrics and high-risk obstetrics offices.”
According to the authors: “Telehealth software and the use of video capture adapters may provide a relatively simple approach to live imaging, as fetal echocardiograms can then be streamed to a picture archiving and communication system for reading. The former allows the pediatric cardiologist to remotely be involved in obtaining a complete fetal echocardiogram.”
There are two ways to perform fetal tele-echocardiography, Srivastava said in an interview.
“No. 1 is real-time transmission of images from the obstetrician’s office being performed by the sonographer to the fetal cardiologist — who can interpret and guide the sonographer to obtain needed images to make a diagnosis and provide prompt diagnosis and management counseling,” she said. “No. 2 is to transfer the images after the imaging is done to the fetal cardiologist to review and provide diagnosis and counseling to the patient via a telehealth communication. This will allow for patients to receive care at their obstetrician’s office and simultaneously have timely access to expert diagnostic services from a fetal cardiologist.”
For more information:
Shubhika Srivastava, MD, can be reached at shubhika.srivastava@nemours.org.
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