Objective: The objective of this study was to assess the potential of the use of asynchronous tele-expertise (ASTE) to provide prenatal diagnosis from a medical and economic point of view. Population: Patients screened by a midwife at a primary center. Methods: A technical and clinical evaluation was conducted retrospectively, and a cost minimization study compared asynchronous tele-expertise to face-to-face consultations that would have been performed without ASTE. Main outcome measures: In our study we assessed the feasibility of TEAS, what were the origins of the requests for expertise, whether patients need to be moved and the reasons for doing so, and the costs of tele-expertise and conventional consultation. Results: In this retrospective analysis 322 advices from 260 patients were interpreted remotely via a platform. The results revealed a 90.68% feasibility of transmitting in a satisfactory and interpretable way ultrasound images and videos via the tele-expertise platform (292/322 files). In our series, asynchronous analysis allowed the required physician to make an accurate diagnosis and identify 74 (28.5%, 95% CI [23% –33.9%]) pregnancies associated with malformations and rule out abnormalities in 186 (71.5%, 95% CI [66.1% –77%]) of the cases. Asynchronous analysis prevented the displacement of 72.7% (189/260) patients. The practice of ASTE would result from a societal point of view, an average saving of \euro 123.40 per patient. Conclusion: The use of asynchronous tele-expertise (ASTE) using fetal ultrasound, is feasible and may contribute to increased diagnostic accuracy while generating a significant reduction in costs for society. Funding: None

Background: The detection rate of congenital heart defects is barely acceptable. Since 2016, the French National Conference on Obstetrical and Foetal Ultrasound updated its recommendations by the inclusion of an examination of the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy. Objectives: This study aimed on the one hand to evaluate the practices related to the realization of the LVOT in the setting of fetal echocardiography in low-risk populations, and on the other hand to study the possible modifications of the practices secondary to the introduction of quality criteria. Study Design: We conducted a multicentric, retrospective and prospective, descriptive, longitudinal study divided into three distinct periods: before 2016, in 2017, and in 2020. Seven quality criteria were investigated and rated from 0 to 1 for LVOT screening. Files were randomly selected from three centers, then average total and specific scores were calculated. Results: LVOT images were present in ultrasound reports in more than 93% of cases. Before 2016, the average quality score was 5.49/7 (95% CI: 5.36-5.62), in 2017 5.91/7 (95% CI: 5.80-6.03), and in 2020 5.70/7 (95% CI: 5.58-5.82) for the three centers. There was no significant difference following the introduction of the quality criteria; 2017 vs. 2020, p = 0.054. Kappa coefficients of the inter- and intra-operator variables were all within 0.601 and 1. Conclusion: Left ventricular outflow tract images were present in most of ultrasound reports. The introduction of the proposed quality criteria is not associated with a significant change in practice.