Indications

Question 1

All of the following are indications for a fetal echocardiography exam EXCEPT:

A. Family history of congenital heart defect
B. History of tuberous sclerosis
C. Extracardiac abnormality
D. Echogenic foci
E. Exposure to teratogenic medications

Answer 1

D. Echogenic foci

Echogenic foci are an incidental finding, and may be seen in approximately 3-4% of all second trimester fetuses. In a low-risk patient, an echogenic focus is considered normal.

Question 2

Which of the following maternal condition is not an indication for a fetal echocardiography exam?

A. Maternal diabetes
B. Maternal connective tissue disorder
C. Maternal use of alcohol
D. Maternal hyperphenylalaninemia (phenylketonuria)
E. Maternal hyperthyroidism

Answer 2

E. Maternal hyperthyroidism

Question 3

Which of the following maternal infections is not an indication for a fetal heart exam?

A. Human immunodeficiency virus (HIV)
B. Rubella
C. Cytomegalovirus
D. Parvovirus
E. Coxsackievirus

Answer 3

A. Human immunodeficiency virus (HIV)

HIV has not been shown to increase the risk of a developmental heart defect. Nevertheless, these maternal infections–rubella, cytomegalovirus, parvovirus, and coxsakievirus– are known to cause direct myocardial damage, which may result in heart failure.

Question 4

Noncardiac fetal anomalies detected on a routine exam may increase the risk for a complex heart defect in that fetus. Which fetal anomaly, if found in isolation, would not warrant further evaluation with a fetal echocardiography exam?

A. Omphalocele
B. Gastroschisis
C. Renal agenesis
D. Dandy-Walker malformation
E. Diaphragmatic hernia

Answer 4

B. Gastroschisis

Some extracardiac anomalies carry a 25-45% risk for an associated complex heart defect, while other fetal defects do not carry any increased risk for a heart defect. Gastroschisis, unlike an omphalocele, is usually an isolated defect. It would not warrant any further fetal echocardiography exam.

Extracardiac anomalies associated with an increased risk for an associated complex heart defects are:

• GI (duodenal atresia, abnormal visceral situs) = 12-22% risk
• Omphalocele = 14-40% risk
• GU (renal dysplasia, renal agenesis, hydronephrosis) = 5=40% risk
• CNS (hydrocephalus, agenesis of corpus callosum, Dandy Walker malformation) = 2-15% risk
• Mediastinum (TE fistula, D-hernia) = 10-40%
• Vascular anomalies (single umbilical artery, persistent right umbilical vein) = no increased risk of cardiac defect when in isolation. When associated with other fetal anomalies, the risk for aneuploidy is 50%

Question 5

Of the fetal findings listed below, which one would not be an indication for a fetal heart examination?

A. Oligohydramnios
B. Polyhydramnios
C. Bradycardia
D. Intrauterine growth restriction
E. A fetal heart rate of 230 bpm

Answer 5

A. Oligohydramnios

Question 6

Maternal exposure to certain medicinal drugs increases a fetus’ risk for a congenital heart defect. Which of the following drugs does not increase the risk of a heart defect?

A. Thalidomide
B. Trimethadione
C. Bradycardia
D. Nifedipine
E. Amphetamines

Answer 6

D. Nifedipine

Nifedipine (trade name Procardia) is a medication prescrived to obstetric patients for preterm labor and contractions. It poses no risk to the developing fetus.

Question 7

If there were a family history of a syndrome, which one would warrant a fetal echocardiography exam?

A. Marfan syndrome
B. DiGeorge syndrome
C. Holt-Oram syndrome (heart-hand syndrome)
D. A and B only
E. All of the above

Answer 7

E. All of the above
(Marfan syndrome, DiGeorge syndrome, Holt-Oram syndrome (heart-hand syndrome))

All syndromes listed are known to be associated with congenital heart disease.