Prenatal detection of congenital heart disease: factors affecting obstetric management and survival
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D C Crawford1, S K Chita, L D Allan
1British Heart Foundation Centre for Perinatal Cardiology, United Medical School, Guy's Hospital, London, England.
Insights
Prenatal diagnosis of fetal congenital heart disease (CHD) identified high-risk pregnancies. Early detection of severe CHD often leads to poor prognosis, with termination being a consideration.
Area of Science:
- Cardiology
- Prenatal Diagnosis
- Medical Imaging
Background:
- Fetal congenital heart disease (CHD) diagnosis and management are critical for prenatal care.
- Accurate prenatal detection of cardiac anomalies aids in planning and intervention.
Purpose of the Study:
- To present experience in diagnosing and managing fetal congenital heart disease (CHD).
- To evaluate the accuracy and outcomes of prenatal echocardiography for fetal cardiac anomalies.
Main Methods:
- Conducted 1757 fetal echocardiograms on 989 antenatal patients over 18 months (Jan 1985-June 1986).
- Analyzed diagnostic accuracy, associated anomalies, pregnancy outcomes, and survival rates.
Main Results:
- Accurately predicted cardiac anomalies in 74 cases; 34 had extracardiac or chromosomal issues.
- 23 pregnancies were terminated; ongoing pregnancies had a 17% survival rate.
- 16 false negative diagnoses occurred, mostly minor anomalies with 81% survival.
Conclusions:
- Prenatal detection of CHD indicates high risk for chromosomal and extracardiac anomalies.
- Detectable fetal CHD is often severe with a poor long-term prognosis.
- Pregnancy termination is a reasonable option for severe anomalies detected early.
Abstract:
Our recent experience in the diagnosis and management of fetal congenital heart disease is presented. During an 18-month period from January 1985 to June 1986, 1757 fetal echocardiograms were performed on a total of 989 antenatal patients. Cardiac anomalies were accurately predicted in 74 cases, 34 of which were associated with extracardiac or chromosomal anomalies. Twenty-three pregnancies were electively terminated. Currently the survival rate for ongoing pregnancies is 17%. A false negative diagnosis was made in 16 cases, the majority involving minor anomalies with a good prognosis and a survival rate of 81%. Prenatal detection of congenital heart disease places the fetus at high risk for chromosomal and extracardiac anomalies. Congenital heart disease detectable during pregnancy is usually severe and associated with a poor long-term prognosis. Termination of the pregnancy may be a reasonable option if a severe anomaly is detected early in pregnancy.