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Prenatal diagnosis of congenital heart disease (CHD) appears to have short-term benefits for the neonate, and may also have long-term benefits in the context of particular critical diagnoses. However, the rate of prenatal CHD detection remains low in the United States, with substantial institutional and regional variation. Recent national and international guidelines recommend extended cardiac views to assist in prenatal diagnosis. As a tertiary care institution in a rural setting, we examined our prenatal detection rate (PDR) from 2002-2015 for quality purposes.
All cases of major CHD (requiring surgical intervention in infancy/early childhood) diagnosed either prenatally or postnatally at our tertiary care center were identified (n=202). We then focused on major CHD in fetuses and/or infants whose mothers had a prenatal anatomic scan in our obstetric ultrasound unit (n=119). Prior to 2010, cardiac views were evaluated with still images; live scanning by MFM was performed only for detailed exams. Starting in 2011, we added specific CINE clips to the cardiac evaluation for all exam types. PDR in our ultrasound unit was reported by year (birth year for live infants, and date of diagnosis for fetuses without a subsequent live birth). Comparisons were by Fishers exact test.
Prenatal detection of major CHD is summarized in Figures 1 and 2. From 2002-2010, there was substantial variability in PDR by year. An abrupt and sustained increase in prenatal detection of major CHD was seen beginning in 2011, with consistent prenatal diagnosis rates of ≥ 90% from 2011 through 2015 (Figure 1). When the role of CINE clips was examined, prenatal diagnosis was made in only 41.5% of major CHD cases without a CINE clip, but in 90.2% of major CHD cases with a CINE clip (p<0.001; OR 13.0 [4.6-37.2] for detection with CINE clips). The relative contribution of CINE clips to prenatal diagnosis of our most frequently encountered major CHD is shown in Figure 2.
Our obstetric ultrasound unit instituted a requirement for cardiac CINE clips as part of our fetal cardiac screen in 2011. The CINE clips encompass all of the extended views which have since been recommended by national and international ultrasound guidelines. Our significant and continued increase in PDR of major CHD is strongly associated with our use of CINE clips. Use of CINE clips appears to be a compelling fetal CHD screening tool.