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226: Prenatal detection of congenital heart disease

      Objective

      Prenatal detection of major congenital heart disease (CHD) improves neonatal survival and reduces morbidity. NHS guidelines suggest a minimum standard with a target of at least 50% of such lesions being detected prenatally. Our objective was to evaluate the precision of prenatal diagnosis of CHD at a single tertiary referral unit (of approximately 8,500 deliveries per year) over a six-year period (2006-2012), encompassing 51,822 deliveries during this time.

      Study Design

      A 100% pediatric ascertainment rate exists in our unit because there is a single national pediatric cardiac treatment and surgery center on the island of Ireland, together with a single perinatal post-mortem system. These databases, together with the Fetal Medicine database, were interrogated for prenatally-identified and postnatally-identified cases of CHD. We identified all cases of major congenital cardiac surgery performed in the first six months of life, together with autopsy results from pregnancy terminations, intrauterine deaths, and neonatal deaths of children not considered candidates for surgery. These data were cross-referenced to maternal prenatal ultrasound reports at our single tertiary referral Fetal Medicine center.

      Results

      The prenatal detection rate for major congenital cardiac disease has increased significantly from 31% to 91% between 2006 and 2012.Using the Cochrane-Armitage trend test, this is a statistically significant increase (p <0.001) See table 1.

      Conclusion

      These improved detection rates have coincided with enhanced targeted staff training in parallel with the introduction of a dedicated combined fetal echocardiography clinic jointly staffed by Maternal Fetal Medicine and Paediatric Cardiology specialists. This data suggest that the implementation of such enhanced screening systems will greatly improve the perinatal management of cases of CHD.
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