Clinical Indications & Risk Factors Flashcards

A gravida presents with a fetal diagnosis of right aortic arch on anatomy scan. What additional evaluation is most appropriate?

Answer: Fetal echocardiography is indicated due to strong association with conotruncal and other cardiac defects

Right aortic arch is strongly associated with conotruncal abnormalities such as tetralogy of Fallot and truncus arteriosus, warranting complete fetal echocardiography.

Phenylketonuria (PKU) that is poorly controlled during pregnancy creates what specific fetal cardiac risk?

Answer: Elevated maternal phenylalanine is a teratogen associated with conotruncal and septal heart defects

Maternal hyperphenylalaninemia from poorly controlled PKU is a known cardiac teratogen associated with conotruncal defects, VSD, and other structural anomalies.

Which structural finding on routine obstetric ultrasound is an established indication for referral for fetal echocardiography?

Answer: Suspected abnormal cardiac axis or position

An abnormal cardiac axis (levocardia, dextrocardia, or mesocardia) is a direct structural concern and a well-established indication for formal fetal echocardiography.

A fetus with heterotaxy (situs ambiguus) is most likely to have which associated cardiac condition?

Answer: Complex congenital heart disease including isomerism and AVSD

Heterotaxy syndrome is almost universally associated with complex congenital heart disease including atrioventricular septal defects, anomalous pulmonary venous return, and isomerism.

In the context of fetal echocardiography referral guidelines, which maternal condition is classified as a cardiac teratogen risk requiring echocardiographic evaluation?

Answer: First-trimester isotretinoin (Accutane) exposure

Isotretinoin (a vitamin A derivative) is a potent teratogen associated with conotruncal heart defects and constitutes a clear indication for fetal echocardiography.

A fetus is found to have an abnormal four-chamber view on the routine anatomy scan. What is the most appropriate next step?

Answer: Immediate referral for complete fetal echocardiography

An abnormal four-chamber view on screening ultrasound is a direct indication for referral to fetal echocardiography for complete structural cardiac assessment.

Which of the following paternal factors constitutes an indication for fetal echocardiography?

Answer: Paternal first-degree relative with congenital heart disease

A paternal first-degree relative with congenital heart disease increases the fetal recurrence risk and is an accepted indication for fetal echocardiography.