Abstract
Objective Few obstetric-specific guidelines detail the indications for screening echocardiography
in pregnancy. The objective of the study is to examine the association of common indications
for maternal echocardiography with the likelihood of abnormality identification, pregnancy
management alteration, and conformity with current American College of Cardiology
Foundation (ACCF) guidelines.
Study Design This retrospective cohort analysis categorized all echocardiograms performed within
pregnancy and the first month postpartum within a tertiary health system to correlate
indications with abnormal findings.
Results Data from 226 echocardiograms were analyzed from 205 women. The most common indication
for initial echocardiography was cardiac symptoms (34.6%). History of cardiac disease
was the only indication demonstrating a significant association with an abnormal finding
on initial echocardiography (odds ratio [OR]: 2.6; p = 0.006). Postpartum status (OR: 4.9; p < 0.001), multiparity (p < 0.001), and tobacco use (OR: 2.2; p = 0.011) were demographic characteristics associated with the identification of abnormal
findings on initial echocardiography. Abnormal echocardiographic findings were associated
with changes in clinical management but did not correlate with adverse obstetric or
neonatal outcomes, which may support the impact of a multidisciplinary programmatic
approach. ACCF appropriateness criteria correlated well with identification of abnormal
echocardiographic results (p = 0.034).
Conclusion Although the presence of cardiac symptoms or history of diabetes failed to demonstrate
association with abnormal echocardiographic findings, a history of prior cardiac disease,
tobacco use, multiparity, and postpartum status were factors associated with identification
of abnormal findings on initial maternal echocardiography. The ACCF appropriateness
criteria for obtaining echocardiography can be applied to pregnant women with consideration
for these additional risk factors.
Key Points
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The ACCF criteria are applicable in pregnancy for appropriateness of echocardiography
indications.
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Several clinical factors often prompt performance of echocardiography in pregnancy
without merit.
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Consideration for multiparty, tobacco abuse, and postpartum state should coincide
with ACCF criteria.
Keywords
echocardiography - pregnancy - guidelines - outcomes - echocardiogram - cardiac disease
