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Prenatal detection of major congenital heart disease - optimising resources to improve outcomes
Siobhan Corcoran1, Kaleigh Briggs2, Hugh O' Connor1
1Royal College of Surgeons in Ireland, Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
Insights
Prenatal screening for congenital heart disease (CHD) significantly improved detection rates from 31% to 91% after protocol changes. This enhancement is crucial for early intervention in major fetal heart abnormalities.
Area of Science:
- Cardiology
- Prenatal Diagnosis
- Public Health
Background:
- Congenital heart disease (CHD) is the most common major structural fetal abnormality.
- Prenatal detection of CHD offers significant benefits for management and outcomes.
- A single national center for pediatric cardiothoracic surgery facilitates comprehensive case ascertainment in Ireland.
Purpose of the Study:
- To evaluate the precision of prenatal diagnosis for CHD before and after implementing a new screening protocol.
- To assess the impact of extended cardiac views, mandatory recalls, and a multidisciplinary Fetal Cardiac clinic on detection rates.
Main Methods:
- Analysis of surgery records from the National Children's Cardiac Centre for major congenital heart defects requiring surgical intervention in the first six months of life.
- Exclusion of minor procedures like patent ductus arteriosus ligation and isolated atrial septal defect repairs.
- Review of the Fetal Medicine database and perinatal pathology mortality data, utilizing the Cochrane-Armitage trend test for statistical significance.
Main Results:
- The incidence of major CHD was 0.5% (238/51,822) during the study period.
- Prenatal detection rates for major CHD increased significantly from 31% to 91% (p<0.001).
- Detection rates for critical duct-dependent lesions improved from 19% to 100%.
Conclusions:
- Multifaceted changes in the prenatal screening protocol led to a dramatic improvement in CHD detection rates.
- Replication of this prenatal program at local levels is essential for improving detection in geographically remote areas.
- Enhanced prenatal diagnosis facilitates timely intervention for major congenital heart defects.
Introduction:
Congenital heart disease (CHD) is the most common major structural fetal abnormality and the benefits of prenatal detection are well described. The objective of this study was to evaluate the precision of prenatal diagnosis at a single tertiary referral unit over two three year periods (2006, 2007, 2008 and 2010, 2011, 2012), before and after a prenatal screening protocol for CHD was developed to include extended cardiac views, mandatory recall for suboptimal views, and a multidisciplinary Fetal Cardiac clinic was established. There exists a single national centre for paediatric cardiothoracic surgery in Ireland, a situation which facilitates near complete case ascertainment.
Materials And Methods:
Surgery records of the National Children's Cardiac Centre were interrogated for all cases of major congenital heart defects requiring surgical intervention in the first six months of life. Minor procedures such as ligation of a patent ductus arteriosus and isolated atrial septal defect repairs were excluded. Analyses of the Fetal Medicine database at the Rotunda Hospital (a stand-alone tertiary level perinatology centre with 8500 deliveries per year) and the mortality data at the Perinatal Pathology department were conducted. The Cochrane-Armitage trend test was used to determine statistical significance in prenatal detection rates over time.
Results:
51,822 women delivered during the study period, and the incidence of major congenital heart disease either that underwent surgical intervention or that resulted in perinatal mortality, was 238/51,822 (0.5%). Prenatal detection of major CHD increased from 31% to 91% (p<0.001). Detection of critical duct-dependant lesions rose from 19% to 100%.
Conclusion:
We attribute the dramatic improvement in prenatal detection rates to the multifaceted changes introduced during the study period. Improved prenatal detection for births that are geographically remote from the National Paediatric Cardiac Centre will require local replication of this prenatal programme.
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