EP09.71: Fetal echocardiography indications: areas of consensus and controversy between guidelines and expert consensus

Fetal echocardiography (FE) is not performed routinely but in the presence of risk factors for fetal congenital heart disease (CHD). Several risk factors have been reported, but these are largely variable among guidelines and expert consensuses. We aimed to report areas of consensus and controversy for FE indications. Guidelines and expert consensuses published between 2014 and 2023 were identified through a systematic literature search. The quality of the guidelines was analysed using the AGREE-II. Documents without FE indications were excluded. All reported risk factors/indications were listed and compared. The agreement/disagreement was classified as follows: complete agreement (all documents reported the same indication); partial agreement (all documents considered a risk factor/indication but with inconsistency in its definition); disagreement (there was an inconsistency for the considered risk factor/indication). We identified 5 documents, covering 17 risk factors/indications. There was a complete agreement for 3 (17.6%): suspected fetal CHD, presence of major extracardiac malformation and non-immune hydrops. Partial agreement was found for 8 (47%): family history of CHD, increased nuchal translucency, suspected fetal arrhythmia (heart rate anomaly), twin pregnancy, maternal diabetes, phenylketonuria, infections, autoimmune pathology. Areas of complete disagreement were identified for 6 (35.2%): hereditary genetic diseases associated with CHD, fetal genetic anomalies, first trimester markers for CHD, venous system or umbilical cord anomalies, pregnancies conceived through ART and teratogen exposure. Areas of complete disagreement regarding which risk factors warrant FE are greater than areas of complete agreement. For around half risk factors/indications there are inconsistencies regarding their definition. An international agreement would be valuable for physicians and guideline developers. For many risk factors, further evidence is needed to justify FE.