OBSTETRICS | Fetal cardiac
Tracks
217
| Saturday, June 14, 2025 |
| 8:45 AM - 10:05 AM |
| 217 | Lecture Rm |
Speaker
Mr Michael Borg
Senior Sonographer
Db Sonic. Sunshine hospital MFM Womens and childrens Hospital Sunshine Hospital
Understanding cyanotic cardiac anomalies
8:45 AM - 9:05 AMAbstract
Cyanotic Cardiac disease is a term used for congenital heart defects which affect oxygen saturation and ultimately result in less nutrient rich blood reaching the lungs and body. These critical congenital heart anomalies can involve valvular abnormalities or issues relating to the connections in the heart.
Its import to understand the anatomical differences between Fetal and Neonate circulation. These fetal Shunts such as Foramen Ovale, Ductus Arteriosus and Ductus Venosus allow fetal circulation to occur effortlessly. During Neonatal circulation the lungs become an active contributor to blood oxygenation. Understanding of the importance of ‘duct dependence’ will greatly impact the delivery of life saving prostaglandin to assist in duct patency and management postnatally.
These anomalies can affect the way blood flows through the heart and lungs. Ultimately causing less blood to flow to the lungs, mixing blue and red blood together causing poor oxygenation. This ultimately results in less oxygenated blood to the body and extremities, causing symptoms such as blue discoloration, dyspnea, and occasionally a heart murmur.
These cardiac anomalies can be classified into 3 common groups, which include right/ left obstructive lesions and mixed lesions.
For a greater appreciation, we will gain a better understanding of Cyanosis and how this is related to the Fetal Heart. Then we will delve into some of the common causes, pathophysiology, ultrasound technique, diagnosis and treatment plans. Management and treatment options will vary on type and extent of the defect, which may range from medications to surgery after birth or years later.
Its import to understand the anatomical differences between Fetal and Neonate circulation. These fetal Shunts such as Foramen Ovale, Ductus Arteriosus and Ductus Venosus allow fetal circulation to occur effortlessly. During Neonatal circulation the lungs become an active contributor to blood oxygenation. Understanding of the importance of ‘duct dependence’ will greatly impact the delivery of life saving prostaglandin to assist in duct patency and management postnatally.
These anomalies can affect the way blood flows through the heart and lungs. Ultimately causing less blood to flow to the lungs, mixing blue and red blood together causing poor oxygenation. This ultimately results in less oxygenated blood to the body and extremities, causing symptoms such as blue discoloration, dyspnea, and occasionally a heart murmur.
These cardiac anomalies can be classified into 3 common groups, which include right/ left obstructive lesions and mixed lesions.
For a greater appreciation, we will gain a better understanding of Cyanosis and how this is related to the Fetal Heart. Then we will delve into some of the common causes, pathophysiology, ultrasound technique, diagnosis and treatment plans. Management and treatment options will vary on type and extent of the defect, which may range from medications to surgery after birth or years later.
Biography
Mr Michael Borg |
Db Sonic/ Imaging Associates
"Michael Borg is a senior Sonographer who currently works at the Joan Kirner Womens and Childrens Hospital Maternal Fetal Medicine department, at Sunshine Victoria. He started his ultrasound training at RPA Hospital in Sydney where his interest in Obstetrics grew. He then moved to Melbourne where he has worked at a number of private and public organisations, including a lengthy period at Monash Health. He had a keen interest in training Obstetrics especially 1st trimester- overseeing the first trimester screening program, presenting at various regional / ASA obstetric events and also actively working within their Fetal diagnostic unit. Michael in 2017 published a review article in 'Sonography' looking at the detection of spina bifida at 11-13 weeks gestation. Later on, he became an academic at CQUniversity and was part of their teaching ultrasound program. This not only helped promote his love for teaching students but also allowed opportunities to observe, explore and teach while visiting hospitals in Vietnam. Now he is an integral part of dB Sonic team affiliated with Sunshine hospital and Western imaging for women, while also working as a Senior Sonographer for Imaging Associates. He also is part of the peer review team for obstetrics articles for ASA "Sonography'.
Mrs Kate Guskich
City Imaging for Women
Venous anomalies
9:05 AM - 9:25 AMBiography
Dr Sri Nidhi Rao
Monash Health
Quantifying fetal heart measurements
9:25 AM - 9:45 AMBiography
Dr Kate Russo
O+G Specialist Sonographer and Senior Lecturer
CQ University/ Adelaide Woman's and Children's Hospital
Intra- and inter-rater reliability of fetal ultrasound abdominal circumference measurement methods in the third trimester
9:45 AM - 9:55 AMAbstract
Introduction: Abdominal circumference (AC) and estimated fetal weight (EFW) are important measures for assessing fetal size and growth. The aim of this study was to determine the intra- and inter-rater reliability and agreement of AC measurement methods.
Methods: This was a prospective study involving two sonographers performing AC measurements on 90 singleton pregnancies between 24-40 weeks’ gestation. Measurements were obtained using ellipse, trace, dot point, and two-dimensional orthogonal diameters (2DOD) methods. Intra- and inter-rater reliability and agreement was assessed using a linear mixed effects model, intraclass correlation and Bland Altman plots.
Results: The marginal AC means were 291.9mm, 297.0mm, 294.4mm and 288.7mm for ellipse, trace, dot point and 2DOD respectively (p < 0.001). Intra-rater reliability was excellent for ellipse, trace, dot point and 2DOD with ICC r values of 0.996, 0.995, 0.995 and 0.992 respectively for sonographer 1 and 0.992, 0.989, 0.992 and 0.986 respectively for sonographer 2. Overall, inter-rater reliability for all methods was excellent with ICC r= 0.974. Bland Altman plots showed very good agreement.
Conclusion: Excellent intra- and inter-rater reliability for all methods. There are systematic differences between AC measures of the four methods. Compared to the ellipse, the 2DOD mean measurement is lower, with trace and dot point both higher. These methods are not interchangeable.
Methods: This was a prospective study involving two sonographers performing AC measurements on 90 singleton pregnancies between 24-40 weeks’ gestation. Measurements were obtained using ellipse, trace, dot point, and two-dimensional orthogonal diameters (2DOD) methods. Intra- and inter-rater reliability and agreement was assessed using a linear mixed effects model, intraclass correlation and Bland Altman plots.
Results: The marginal AC means were 291.9mm, 297.0mm, 294.4mm and 288.7mm for ellipse, trace, dot point and 2DOD respectively (p < 0.001). Intra-rater reliability was excellent for ellipse, trace, dot point and 2DOD with ICC r values of 0.996, 0.995, 0.995 and 0.992 respectively for sonographer 1 and 0.992, 0.989, 0.992 and 0.986 respectively for sonographer 2. Overall, inter-rater reliability for all methods was excellent with ICC r= 0.974. Bland Altman plots showed very good agreement.
Conclusion: Excellent intra- and inter-rater reliability for all methods. There are systematic differences between AC measures of the four methods. Compared to the ellipse, the 2DOD mean measurement is lower, with trace and dot point both higher. These methods are not interchangeable.
Biography
Dr Kate Russo |
CQ University/ Adelaide Woman's and Children's Hospital
Kate enjoys working as a senior lecturer in the master’s ultrasound program at Central Queensland University and as a specialist sonographer in obstetrics and gynaecology for SA Medical Imaging at the Women’s and Children’s Hospital in Adelaide. Her ultrasound career started in Brisbane in 1998, where she spent five years before moving to the United Kingdom. While in London, Kate developed her passion in fetal medicine before returning to Adelaide in 2008. She has a special interest in fetal echocardiography and research, completing her PhD titled ‘Maternal cardiac function in women high-risk for pre-eclampsia’ in 2020. Kate continues to be involved with research and regularly gives presentations locally and nationally, aiming to improve obstetric ultrasound services for women through education. She is a passionate advocate for the advancement of sonographers and strives for continuous improvement in the quality of sonographer practice, communication and person-centred care.
Ms Helen Payne
Sonographer
Tiny Tickers Fetal Heart
To image or not to image. A legal view of whether archiving of fetal heart images images should be standardised at the 20-week screening scan.
9:55 AM - 10:05 AMAbstract
Introduction:The Fetal Anatomy Screening Programme (FASP) 20-week scan guidelines advise that ‘there is no requirement to archive images of the fetal cardiac protocol views’. This has led to a variance in practice between different hospitals, some archive fetal cardiac images and others do not. The National Institute for Cardiovascular Outcomes Research (NICOR) found that detection rates for CHD vary between 24% and 72% depending upon the geographical area. In contrast to FASP, NICOR suggest that to reduce regional variation ‘several steps should be considered: storage of specific cardiac views to allow internal and external review to encourage a learning process and standardised pathways of feedback’.
Methods: Using both medical and legal texts and academic journals, it was considered whether fetal heart images should be archived and the medicolegal advantages and disadvantages of doing so.
Results: There is no medicolegal reason not to archive images of the fetal heart. The benefits of storing images are increased patient confidence, learning from incidents and improved sonographer training.
Conclusion: Storing fetal heart images should be standardised nationally.
Take home message: Defensive practice and medico-legal considerations should not override consistent patient care.
Methods: Using both medical and legal texts and academic journals, it was considered whether fetal heart images should be archived and the medicolegal advantages and disadvantages of doing so.
Results: There is no medicolegal reason not to archive images of the fetal heart. The benefits of storing images are increased patient confidence, learning from incidents and improved sonographer training.
Conclusion: Storing fetal heart images should be standardised nationally.
Take home message: Defensive practice and medico-legal considerations should not override consistent patient care.
Biography
Ms Helen Payne |
Tiny To let’s Fetal Heart Charity/ Mid Cheshire Hospitals NHS Trust
BSc Diagnostic Radiographer 2003-2006
Postgraduate Diploma Medical Ultrasound 2008-2009
Current Study - Master of Laws (LLM) Medical Law and Ethics - To complete February 2025
16 years NHS ultrasound experience as an advanced practice reporting sonographer.
Experience in the private ultrasound sector.
Expert witness for ultrasound Obstetrics and Gynaecology for both the Society of Radiographers and AMG, a private medico-legal consultancy business.
Trainer for fetal heart charity Tiny Tickers.
Experience as a lecturer in obstetrics, general and gynaecological ultrasound
Speaker at vascular ultrasound conference 2023 and 2025
Senior leader at Rainbow for Africa charity, experience obstetric training in Kenya.
