Correlation Between Prenatally Diagnosed Pericardial Effusion and Neonatal Echocardiogram

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of Ultrasound in Medicine

Abstract

Objectives: Prenatally diagnosed pericardial effusion(PE) is a common referral indication to tertiary fetal imaging units for a fetal echocardiogram. A standardized method of diagnosing a fetal PE is not well defined, particularly in mild or isolated cases. The significance of fetal PE after resolution has also not been well-elucidated. We evaluated whether sonographic parameters identified in prenatally diagnosed cases of PE were associated with abnormal neonatal echocardiograms or adverse outcomes. Methods: Following Institutional Review Board approval, we conducted a retrospective cohort study of single-ton pregnancies from 2013 to 2020 at a university teaching hospital with a prenatally diagnosed PE and who underwent a neonatal echocardiogram. Image review was conducted foreach prenatal PE to evaluate the following sonographic parameters: whether visualized with color Doppler, if visible in multiple planes, the location, the size at the AV valve, the size in end-diastole, and the maximum measurement at diagnosis and in pregnancy. Chart review was conducted to abstract relevant maternal, fetal, and delivery complications. Neonatal charts were reviewed for the neonatal echocardiogram findings, including whether a PE was identified on postnatal imaging. Descriptive statistics were used to summarize the data. Chi-square and Mann–Whitney U tests were used to compare the prenatal sonographic parameters between the abnormal and normal neonatal echocardiograms. Results: During this study period, we identified 120 singleton pregnancies who had a prenatally diagnosed PE and a neonatal echocardiogram. The average gestational age at diagnosis was 27.2 ± 6.2 weeks of gestation. Diagnosis occurred at fetal echocardiograms, standard and detailed anatomy surveys, and follow up ultrasounds. At prenatal diagnosis, the average maximal measurement was 3.3 ± 1.4 mm, and the average measurement at end-diastole was 1.67 ± 1.2 mm. In79.2% of cases, the maximal PE measurement was over2 mm. In 11.7% of cases, the PE was visualized in 2 or more planes. Prenatally diagnosed PE was seen in a 45-degree 4-chamber cardiac view in nearly half of the cohort (45.8%)and was most commonly a partial PE (58.3%). The PE was distinct from the myocardium on color Doppler in 30.8% of cases. An isolated PE without any cardiac or noncardiac fetal anomalies was identified in 30.0% of cases. In 61.7% of cases, the PE resolved on prenatal imaging. An abnormal neonatal echocardiogram was identified in 70.0% of cases, and a neonatal PE persisted in 15.0%. Of the cardiac abnormalities, the most frequent findings were patent foramen ovale, patent ductus arteriosus, ventricular septal defect, atrial septal defect, and right ventricular hypertrophy. NICU admission occurred in 47.5% of cases, although the average gestational age at delivery was 37.2 ± 3.2 weeks of gestation. In this cohort, there were 0 cases of intrauterine fetal demise and 3 cases of neonatal demise. When comparing the sonographic PE parameters measured prenatally between those with an abnormal neonatal echocardiogram compared to a normal neonatal echo-cardiogram, we did not identify a significant difference. Conclusions: Although many cases of PE appear to resolve during pregnancy, the presence of a PE at any time confers a high rate of abnormal neonatal echocardiogram and NICU admission. Though the individual sonographic parameters did not provide utility in predicting an abnormal postnatal echocardiogram, a detailed fetal evaluation and a postnatal echocardiogram should be undertaken in cases of prenatally diagnosed PE.

Volume

44

Issue

S1

First Page

S33

Comments

American Institute of Ultrasound in Medicine 2025 AIUM Annual Convention, March 29 - April 1, 2025, Orlando, FL

Last Page

S33

DOI

10.1002/jum.43_70067

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