The Cardiovascular Profile Score in Patients with Non-immune Hydrops Fetalis and Cardiac Anomalies - a Pilot Study

Abstract

The purpose of this paper is to explore whether the cardiovascular profile score (CVPS) correlates with fetal outcome in patients with non-immune hydrops fetalis (NIHF) and cardiac anomalies. In this retrospective study, we included fetuses with NIHF and the suspicion of a cardiac anomaly in prenatal ultrasound. The CVPS was calculated using information obtained by fetal echocardiographic examination. Feto-neonatal mortality (FNM) was defined as intrauterine fetal demise or death in the first 6 months of life. We reviewed 98 patients, who were referred to the Department of Obstetrics and Gynecology of the Johannes Gutenberg University in Mainz with the diagnosis of NIHF between January 2007 and March 2021. By eighteen of them, the suspicion of a cardiac anomaly was raised. After exclusion of six pregnancies (one termination of pregnancy and five because of incomplete data), 12 cases were left for analysis. Mean gestational age at which the CVPS was calculated was 29 + 2 weeks. Two fetuses died in utero. Of the remaining ten hydropic fetuses, three newborns died in the neonatal period, and seven survived after a 6-month surveillance period. Median CVPS of all fetuses was 6 points. Surviving fetuses showed statistically significantly higher CVPS values (median 8 points) than fetuses with FNM (median 5 points, p value = 0.009). Our results point towards a positive association between CVPS and fetal outcome in fetuses with NIHF and cardiac anomalies. The CVPS appears to be a useful marker in the assessment of heart failure in utero.

Keywords: Cardiac anomalies; Cardiovascular profile score; Fetal outcome; Non-immune hydrops fetalis.

Fig. 1

Case 1 at 24 + 1 weeks of gestation, skin edema measuring 7.4 mm, CVPS 5 points (skin edema: 0 points, mild cardiomegaly (cardiothoracic area ratio = 0.45): 1 point, mitral valve regurgitation: 0 points, normal arterial Doppler flow velocimetry: 2 points, normal venous Doppler flow velocimetry: 2 points)

Fig. 2

Case 3 at 23 + 4 weeks of gestation with severe cardiomegaly, CVPS 4 points, (ascites, pleural effusions: 1 point, severe cardiomegaly (cardiothoracic area ratio = 0.59): 0 points, tricuspid valve regurgitation: 1 point, normal arterial Doppler flow velocimetry: 2 points, pulsatile umbilical vein: 0 points), yellow arrow: heart, white arrow: skin edema

Fig. 3

Case 3 at 23 + 4 weeks of gestation, here illustration of the holosystolic tricuspid valve regurgitation

Fig. 4

Case 11 at 30 + 0 weeks of gestation, CVPS 8 points (skin edema: 0 points, cardiothoracic area ratio = 0.28: 2 points, competent tricuspid and mitral valve: 2 points, normal arterial Doppler flow velocimetry: 2 points, normal venous Doppler flow velocimetry: 2 points)

Fig. 5

Case 2 at 31 + 6 weeks of gestation, CVPS 4 points (ascites, pleural effusions, generalized skin edema,: 0 points, mild cardiomegaly (cardiothoracic area ratio = 0.45): 1 point, competent tricuspid and mitral valve: 2 points, umbilical artery Doppler velocimetry with reverse end-diastolic flow: 0 points, ductus venosus with reversed a wave: 1 point)

Fig. 6

Case 9 at 32 + 6 weeks of gestation, CVPS 6 points (ascites, pleural effusions, generalized skin edema: 0 points, cardiothoracic area ratio = 0.2: 2 points, tricuspid valve regurgitation: 1 point, umbilical artery Doppler velocimetry with zero end-diastolic flow: 1 point, normal venous Doppler flow velocimetry: 2 points), yellow arrow: pleural effusion, white arrow: skin edema

Fig. 7

Case 2 at 31 + 6 weeks of gestation, here illustration of the blood flow pattern in the ductus venosus with reversed a wave (yellow arrow)