Advertisement

Journal of Fetal Medicine

, Volume 5, Issue 4, pp 225–231 | Cite as

Trends and Outcomes After Prenatal Diagnosis of Congenital Cardiac Defects: Experience of a Dedicated Fetal Medicine Centre from South India

  • Shyama Devadasan
  • Bijoy Balakrishnan
  • Meenu Batra
  • P. S. Sreeja
  • N. Patil Swapneel
  • K. K. Gopinathan
Original Article
  • 17 Downloads

Abstract

The primary objective of the study was to present a 5-year data on the outcomes after prenatal diagnosis of CHD. This is a retrospective descriptive study, conducted in the fetal medicine unit of an academic tertiary care referral centre in South India. The details of all cases with a prenatal diagnosis of fetal cardiac lesions from January 2012 through December 2016 were collected. All cases were systematically analyzed for type of lesion, associated malformations, chromosomal abnormalities, prognosis of the lesion, the decision taken by the couples and the information regarding post natal outcome, wherever available. Prenatally diagnosed fetal cardiac lesions were identified in 310 cases. In 220 (76.1%) cases, the couple opted for termination of pregnancy. In this group, 52% of them had an isolated cardiac defect with good prognosis. In the rest of the 69 cases who decided to continue, 7 cases had an IUD. In the 62 cases that culminated in a live birth, 46 cases opted for postnatal cardiac care. Corrective surgery was attempted in 18 neonates with 2 resulting in neonatal death. Prenatal diagnosis of isolated CHD provides an opportunity for an improved immediate neonatal outcome. A thorough evaluation for extracardiac and genetic abnormality will facilitate better utilization of health care resources by triaging patients with isolated CHD having good prognosis for targeted postnatal care. Also, antenatal pediatric cardiology counselling will enable the couple to make decisions regarding postnatal management options.

Keywords

Congenital heart defect Echocardiography Conotruncal anomalies Perinatal outcomes Ventricular septal defect Conotruncal abnormality Karyotypic abnormality Extra-cardiac malformation 

References

  1. 1.
    Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Col Cardiol. 2002;39(12):1890–900.CrossRefGoogle Scholar
  2. 2.
    Wigton TR, Sabbagha RE, Tamura RK, Cohen L, Minogue JP, Strasburger JF. Sonographic diagnosis of congenital heart disease: comparison between the four-chamber view and multiple cardiac views. Obstet Gynecol. 1993;82(2):219–24.PubMedGoogle Scholar
  3. 3.
    Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181(2):446–54.CrossRefGoogle Scholar
  4. 4.
    Queisser-Luft A, Stopfkuchen H, Stolz G, Schlaefer K, Merz E. Prenatal diagnosis of major malformations: quality control of routine ultrasound examinations based on a five-year study of 20 248 newborn fetuses and infants. Prenat Diagn. 1998;18(6):567–76.CrossRefGoogle Scholar
  5. 5.
    Wren C, Reinhardt Z, Khawaja K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed. 2008;93(1):F33–5.CrossRefGoogle Scholar
  6. 6.
    Abu-Harb M, Hey E, Wren C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child. 1994;71(1):3–7.CrossRefGoogle Scholar
  7. 7.
    International Society of Ultrasound in Obstetrics & Gynecology. Cardiac screening examination of the fetus: guidelines for performing the ‘basic’ and ‘extended basic’ cardiac scan. Ultrasound Obstet Gynecol. 2006;27(1):107.Google Scholar
  8. 8.
  9. 9.
    Carvalho JS, Mavrides E, Shinebourne EA, Campbell S, Thilaganathan B. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart. 2002;88(4):387–91.CrossRefGoogle Scholar
  10. 10.
    Garne E, Stoll C, Clementi M. Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries. Ultrasound Obstet Gynecol. 2001;17(5):386–91.CrossRefGoogle Scholar
  11. 11.
    Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart. 2000;84(3):294–8.CrossRefGoogle Scholar
  12. 12.
    Gardiner HM. Fetal echocardiography: 20 years of progress. Heart. 2001;86(suppl 2):ii12–122.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Tegnander E, Eik-Nes SH. The examiner’s ultrasound experience has a significant impact on the detection rate of congenital heart defects at the second-trimester fetal examination. Ultrasound Obstet Gynecol. 2006;28(1):8–14.CrossRefGoogle Scholar
  14. 14.
    Sharland G. Fetal cardiac screening and variation in prenatal detection rates of congenital heart disease: why bother with screening at all? Future Cardiol. 2012;8(2):189–202.CrossRefGoogle Scholar
  15. 15.
    Allan L. Antenatal diagnosis of heart disease. Heart. 2000;83(3):367.CrossRefGoogle Scholar
  16. 16.
    Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30 149 fetuses—detection rates and outcome. Ultrasound Obstet Gynecol. 2006;27(3):252–65.CrossRefGoogle Scholar
  17. 17.
    Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Kachaner J, Sidi D. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation. 1999;99(7):916–8.CrossRefGoogle Scholar
  18. 18.
    Jaeggi ET, Sholler GF, Jones OD, Cooper SG. Comparative analysis of pattern, management and outcome of pre-versus postnatally diagnosed major congenital heart disease: a population-based study. Ultrasound Obstet Gynecol. 2001;17(5):380–5.CrossRefGoogle Scholar
  19. 19.
    Vaidyanathan B, Kumar S, Sudhakar A, Kumar RK. Conotruncal anomalies in the fetus: referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India. Ann Pediatr Card. 2013;6(1):15.CrossRefGoogle Scholar
  20. 20.
    Allan LD, Apfel HD, Printz BF. Outcome after prenatal diagnosis of the hypoplastic left heart syndrome. Heart. 1998;79(4):371–3.CrossRefGoogle Scholar
  21. 21.
    Sharland GK, Lockhart SM, Chita SK, Allan LD. Factors influencing the outcome of congenital heart disease detected prenatally. Arch Dis Child. 1991;66(3):284–7.CrossRefGoogle Scholar
  22. 22.
    Tennstedt C, Chaoui R, Körner H, Dietel M. Spectrum of congenital heart defects and extracardiac malformations associated with chromosomal abnormalities: results of a seven year necropsy study. Heart. 1999;82(1):34–9.CrossRefGoogle Scholar
  23. 23.
    Haak MC, Bartelings MM, Groot GD, Van Vugt JM. Cardiac malformations in first-trimester fetuses with increased nuchal translucency: ultrasound diagnosis and postmortem morphology. Ultrasound Obstet Gynecol. 2002;20(1):14–21.CrossRefGoogle Scholar
  24. 24.
    Hafner E, Schuchter K, Liebhart E, Philipp K. Results of routine fetal nuchal translucency measurement at weeks 10–13 in 4233 unselected pregnant women. Prenat Diagn. 1998;18(1):29–34.CrossRefGoogle Scholar
  25. 25.
    Chaoui R, Körner H, Tennstedt C, et al. Prenatal diagnostizierte Herzfehlbildungen und assoziierte Chromosomenaberrationen. Ultraschall Med. 1996;17:17.Google Scholar
  26. 26.
    Gembruch U, Bald R, Redel D, et al. Bedeutung der pränatalen Diagnostikangeborener Herzfehler. In: Jahrbuch der Gynäkologie und Geburtshilfe. Munich: Biermann-Verlag; 1991. p. 107–18.Google Scholar
  27. 27.
    Allan LD, Cook A, Sullivan I, Sharland GK. Changing birth prevalence of the hypoplastic left heart syndrome as a result of fetal echocardiography. Lancet. 1991;337:959–63.CrossRefGoogle Scholar
  28. 28.
    Holland BJ, Myers JA, Woods CR. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol. 2015;45(6):631–8.CrossRefGoogle Scholar

Copyright information

© Society of Fetal Medicine 2018

Authors and Affiliations

  1. 1.Department of Feto-Maternal Medicine, Centre for Infertility Management and Assisted Reproduction (CIMAR)Edappal Hospitals Pvt. Ltd.EdappalIndia

Personalised recommendations