{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:35:02Z","timestamp":1787762102305,"version":"build-2784847793"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cardiac heart defects affect nearly 6\u201312 per 1000 live births in the general population and are more frequent than common trisomies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>\n                      To assess the efficacy and technical limitations of first-trimester fetal heart evaluation in the 11\u201314\n                      <jats:sup>th<\/jats:sup>\n                      -weeks\u2019 scan and comparison with the second-trimester anatomical exam by ultrasound.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Method:<\/jats:title>\n                    <jats:p>Between April 2015 and July 2020, medical records and ultrasound data of 3295 pregnancies who underwent first-trimester fetal anatomy exams by ultrasound were reviewed retrospectively. All ultrasound exams were performed by the same two operators (TUKD, OP) with transabdominal transducers. Fetal situs, four-chamber view, outflow tracts, and three-vessel trachea view are the cornerstones of first-trimester fetal heart examination. Conventional grayscale mode and high-definition power Doppler mode were utilized. The same operators re-examined all cases between the 18 and 23 weeks of gestation by ISUOG guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We performed a combined transvaginal and transabdominal approach for only 101 cases (3.06%). The mean maternal age was 31.28 \u00b1 4.43, the median gestational age at the first-trimester ultrasound exam was 12.4 weeks, and the median CRL was 61.87 mm (range was 45.1\u201384 mm). Even combined approach situs, cardiac axis, and four-chamber view could not be visualized optimally in 28 cases (0.7%). Outflow tracts were visualized separately in 80% (2636 in 3295) cases. Three vessel-trachea views were obtained in 85.4% (2814 in 3295) cases by high-definition Doppler mode. There were 47 fetuses with cardiac defects in 3295 pregnancies with the known pregnancy outcome. Ten cases had abnormal karyotype results. Thirty-two fetuses with cardiac anomalies (9.7 in 1000 pregnancies) were detected in the first-trimester examination, and the remaining 15 (4.55 in 1000 pregnancies) cases were diagnosed in the second-trimester examination. The prevalence of congenital cardiac anomalies was 14.25 in 1000 pregnancies. Fifteen cases were missed in the first-trimester exam. Also, ten fetuses which had abnormal cardiac findings in the first-trimester exam were not confirmed in the second-trimester exam. Sensitivity, specificity, positive, and negative predictive values were calculated as 65.3%, 99.7%, 66.8%, and 99.67%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Late first-trimester examination of the fetus is feasible and allows earlier detection of many structural abnormalities of the fetus, including congenital heart defects. Suspicious and isolated cardiac abnormal findings should be re-examined and confirmed in the second-trimester exam. Previous abdominal surgery, high BMI, and subtle cardiac defects can cause missed cardiac abnormalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/njcp.njcp_757_22","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T06:01:14Z","timestamp":1689314474000},"page":"787-794","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation Fetal Heart in the First and Second Trimester: Results and Limitations"],"prefix":"10.4103","volume":"26","author":[{"given":"TUK","family":"Dilek","sequence":"first","affiliation":[{"name":"Halic University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Oktay","sequence":"additional","affiliation":[{"name":"Acibadem Bakirk\u00f6y Hospital, Pediatric Cardiology Clinic, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EG","family":"Aygun","sequence":"additional","affiliation":[{"name":"Acibadem Bakirk\u00f6y Hospital, Pediatric Cardiology Clinic, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"\u00dcnsal","sequence":"additional","affiliation":[{"name":"Acibadem Mehmet Ali Aydinlar University, Atakent Hospital, Obstetrics and Gynecology Clinic and IVF Unit, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6","family":"Pata","sequence":"additional","affiliation":[{"name":"Ac\u0131badem Mehmet Ali Aydinlar University, School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"R1-20240907","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S0002-9378(94)70040-0","article-title":"A randomized trial of prenatal ultrasonographic screening:Impact on the detection, management, and outcome of anomalous fetuses","volume":"171","author":"Crane","year":"1994","journal-title":"The RADIUS Study Group. Am J Obstet Gynecol"},{"key":"R2-20240907","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/S0002-9378(99)70577-6","article-title":"The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study","volume":"181","author":"Grandjean","year":"1999","journal-title":"Am J Obstet Gynecol"},{"key":"R3-20240907","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3345\/kjp.2011.54.5.183","article-title":"Congenital heart disease in the newborn requiring early intervention","volume":"54","author":"Yun","year":"2011","journal-title":"Korean J Pediatr"},{"key":"R4-20240907","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/pd.4525","article-title":"Prenatal detection of congenital heart disease in a low risk population undergoing first and second trimester screening","volume":"35","author":"J\u00f8rgensen","year":"2015","journal-title":"Prenat Diagn"},{"key":"R5-20240907","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/uog.2710","article-title":"Prenatal detection of heart defects in a non-selected population of 30,149 fetuses--detection rates and outcome","volume":"27","author":"Tegnander","year":"2006","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R6-20240907","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/uog.2804","article-title":"The examiner's ultrasound experience has a significant impact on the detection rate of congenital heart defects at the second-trimester fetal examination","volume":"28","author":"Tegnander","year":"2006","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R7-20240907","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/uog.20358","article-title":"Why are congenital heart defects being missed?","volume":"55","author":"van Nisselrooij","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R8-20240907","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/pd.2281","article-title":"The nuchal translucency and the fetal heart:A literature review","volume":"29","author":"Clur","year":"2009","journal-title":"Prenat Diagn"},{"key":"R9-20240907","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1159\/000322138","article-title":"Contribution of ductus venosus Doppler in first-trimester screening for major cardiac defects","volume":"29","author":"Chelemen","year":"2011","journal-title":"Fetal Diagn Ther"},{"key":"R10-20240907","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1097\/AOG.0b013e31821aa720","article-title":"Contribution of fetal tricuspid regurgitation in first-trimester screening for major cardiac defects","volume":"117","author":"Pereira","year":"2011","journal-title":"Obstet Gynecol"},{"key":"R11-20240907","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1002\/pd.2831","article-title":"Fetal cardiac evaluation at 11-14 weeks by experienced obstetricians in a low-risk population","volume":"31","author":"Volpe","year":"2011","journal-title":"Prenat Diagn"},{"key":"R12-20240907","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/uog.17246","article-title":"Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance","volume":"50","author":"Karim","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R13-20240907","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/AOG.0000000000000015","article-title":"Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies:A systematic review","volume":"122","author":"Rossi","year":"2013","journal-title":"Obstet Gynecol"},{"key":"R14-20240907","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1002\/uog.12342","article-title":"ISUOG practice guidelines:Performance of first trimester fetal ultrasound scan","volume":"41","author":"Salamon","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R16-20240907","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1046\/j.1469-0705.2002.00739.x","article-title":"Nicolaides Kin first-trimester fetuses with increased nuchal translucency:Ultrasound diagnosis and postmortem morphology","volume":"20","author":"Syngelaki","year":"2002","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R17-20240907","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1002\/pd.1442","article-title":"Fetal echocardiography during routine first-trimester screening:A feasibility study in an unselected population","volume":"26","author":"Vimpelli","year":"2006","journal-title":"Prenat Diagn"},{"key":"R18-20240907","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/pd.2642","article-title":"Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks","volume":"31","author":"Syngelaki","year":"2011","journal-title":"Prenat Diagn"},{"key":"R19-20240907","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/uog.12403","article-title":"ISUOG practice guidelines (updated):sonographic screening examination of the fetal heart","volume":"41","author":"Carvalho","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R20-20240907","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1046\/j.1469-0705.1996.07040245.x","article-title":"Abnormalities of the heart and great arteries in chromosomally normal fetuses with increased nuchal translucency thickness at 11-13 weeks of gestation","volume":"7","author":"Hyett","year":"1996","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R21-20240907","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/j.ajog.2004.12.086","article-title":"Elevated first-trimester nuchal translucency increases the risk of congenital heart defects","volume":"192","author":"Bahado-Singh","year":"2005","journal-title":"Am J Obstet Gynecol"},{"key":"R22-20240907","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1080\/14767058.2019.1637849","article-title":"The outcome of structural heart defects diagnosed in the first trimester of pregnancy","volume":"34","author":"Duta","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"R23-20240907","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1046\/j.1469-0705.2002.00739.x","article-title":"Cardiac malformations in first-trimester fetuses with increased nuchal translucency:ultrasound diagnosis and postmortem morphology","volume":"20","author":"Haak","year":"2002","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R24-20240907","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/uog.21956","article-title":"Diagnosis of major heart defects by routine first-trimester ultrasound examination:Association with increased nuchal translucency, tricuspid regurgitation and abnormal flow in ductus venosus","volume":"55","author":"Minnella","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R25-20240907","doi-asserted-by":"crossref","first-page":"173","DOI":"10.7863\/jum.2006.25.2.173","article-title":"Early fetal echocardiography:Heart biometry and visualization of cardiac structures between 10 and 15 weeks'gestation","volume":"25","author":"Smrcek","year":"2006","journal-title":"J Ultrasound Med"},{"key":"R26-20240907","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1046\/j.1469-0705.2002.00733.x","article-title":"Fetal cardiac abnormalities identified prior to 14 weeks'gestation","volume":"20","author":"Huggon","year":"2002","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R27-20240907","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1002\/pd.2831","article-title":"Fetal cardiac evaluation at 11-14 weeks by experienced obstetricians in a low-risk population","volume":"31","author":"Volpe","year":"2011","journal-title":"Prenat Diagn"},{"key":"R28-20240907","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1002\/uog.8934","article-title":"Fetal echocardiography at 11-13 weeks by transabdominal high-frequency ultrasound","volume":"37","author":"Persico","year":"2011","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R29-20240907","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ejogrb.2018.11.030","article-title":"Early fetal ultrasound screening for major congenital heart defects without Doppler","volume":"233","author":"Garc\u00eda Fern\u00e1ndez","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"R30-20240907","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1515\/jpm-2019-0222","article-title":"Fetal heart examination at the time of 13 weeks scan:A 5 years'prospective study","volume":"47","author":"Ebrashy","year":"2019","journal-title":"J Perinat Med"},{"key":"R31-20240907","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/0002-9378(91)90310-N","article-title":"Transvaginal fetal echocardiography in early pregnancy:Normative data","volume":"165","author":"Dolkart","year":"1991","journal-title":"Am J Obstet Gynecol"},{"key":"R32-20240907","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1159\/000020970","article-title":"Biometry of the fetal heart between 10 and 17 weeks of gestation","volume":"15","author":"Gembruch","year":"2000","journal-title":"Fetal Diagn Ther"},{"key":"R33-20240907","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1046\/j.1469-0705.2002.00735.x","article-title":"How successful is fetal echocardiographic examination in the first trimester of pregnancy?","volume":"20","author":"Haak","year":"2002","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R34-20240907","doi-asserted-by":"crossref","first-page":"161","DOI":"10.7863\/ultra.34.1.161","article-title":"Factors affecting the feasibility of routine first-trimester fetal echocardiography","volume":"34","author":"Nemescu","year":"2015","journal-title":"J Ultrasound Med"},{"key":"R35-20240907","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1002\/uog.8814","article-title":"Defining the fetal cardiac axis between 11 +0 and 14 +6 weeks of gestation:Experience with 100 consecutive pregnancies","volume":"36","author":"Sinkovskaya","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R36-20240907","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/AOG.0000000000000608","article-title":"Fetal cardiac axis and congenital heart defects in early gestation","volume":"125","author":"Sinkovskaya","year":"2015","journal-title":"Obstet Gynecol"},{"key":"R37-20240907","doi-asserted-by":"crossref","first-page":"563","DOI":"10.7863\/jum.2012.31.4.563","article-title":"Diagnosis of congenital heart disease by early and second-trimester fetal echocardiography","volume":"31","author":"Volpe","year":"2012","journal-title":"J Ultrasound Med"},{"key":"R38-20240907","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1002\/uog.10148","article-title":"Ultrasound safety in early pregnancy:Reduced energy setting does not compromise obstetric Doppler measurements","volume":"39","author":"Sande","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"key":"R39-20240907","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ultrasmedbio.2014.08.010","article-title":"Acoustic output measured by thermal and mechanical indices during fetal echocardiography at the time of the first trimester scan","volume":"41","author":"Nemescu","year":"2015","journal-title":"Ultrasound Med Biol"}],"container-title":["Nigerian Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_757_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:14:30Z","timestamp":1787760870000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_757_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/njcp.njcp_757_22","relation":{},"ISSN":["1119-3077","2229-7731"],"issn-type":[{"value":"1119-3077","type":"print"},{"value":"2229-7731","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6]]},"assertion":[{"value":"2022-11-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}