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Antenatal cardiac anomaly – fetal echo — RACP Paediatrics MCQ

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HardCardiologyAntenatal cardiac anomaly – fetal echoRACP Paediatrics

At 21 weeks, the fetal four-chamber view appears normal, but the three-vessel-trachea view shows an abnormal vessel relationship and a right-sided aortic arch. No extracardiac anomaly is seen. What is the next cardiac investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Refer for specialist fetal echocardiography and prenatal cardiac counselling

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

A is correct because an abnormal outflow or three-vessel-trachea view is a suspected cardiac anomaly and requires specialist fetal echocardiography even when the four-chamber view is normal. B repeats the view least likely to characterise conotruncal and arch anatomy. C can miss the opportunity for prenatal diagnosis, counselling and delivery planning. D introduces ionising radiation and is not the standard next investigation. E does not define fetal anatomy. ISUOG fetal-cardiac guidance is jurisdiction-neutral, is used in Australian ultrasound practice and does not conflict with local antenatal pathways.

Reference: Queensland Health, antenatal ultrasound referral guideline: https://metronorth.health.qld.gov.au/wp-content/uploads/2020/06/mfm-guidelines-antenatal-ultrasound-refer.pdf; ISUOG 2023 Practice Guideline, fetal cardiac screening: https://www.isuog.org/resource/updated-isuog-practice-guidelines-fetal-cardiac-screening.html