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Factors influencing the prenatal detection of structural congenital heart diseases
Author(s) -
Wong S.F.,
Chan F.Y.,
Cincotta R.,
LeeTannock A.,
Ward C.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.abs15-4.x
Subject(s) - medicine , heart disease , ductus arteriosus , pediatrics , fetal echocardiography , incidence (geometry) , prenatal diagnosis , fetus , obstetrics , body mass index , concomitant , pregnancy , surgery , cardiology , physics , biology , optics , genetics
Background: Congenital heart disease is the commonest congenital anomaly, but the reported antenatal detection rate varies widely from 4.5 to 36%. Purpose: To assess the factors influencing the antenatal detection rate of structural congenital heart diseases. Methods: A retrospective study was conducted at a major obstetric hospital in Australia between 1st January 1996 and 30th June 1999. The medical records of all fetuses and infants born with congenital heart diseases, except isolated patent ductus arteriosus, were reviewed. Only pregnancies that had antenatal ultrasound scan assessments for morphological surveys were included. The antenatal detection rate for structural congenital heart diseases was determined. The following factors that might influence the detection rate, were assessed: complexity of the lesions; experience of the sonologists (performance in tertiary vs. non‐tertiary institutions); identification of other structural or chromosomal anomalies; and maternal body mass index. Results: The incidence of structural congenital heart disease in this series, excluding cases referred from other hospitals, was 7‰ (179/25529). One‐hundred and fifty‐three fetuses and babies with structural congenital cardiac diseases were included. The overall detection rate for congenital heart diseases in this series was 39.9%. Detection rates for isolated septal defects were poor (13.2%). The detection rates were significantly higher for complex lesions (54%), for lesions with concomitant septal defects (47.6%), and for lesions with abnormal four chamber views (62.9%). The detection rate was also higher if the scan was performed in the tertiary institution (59%), and if there were other chromosomal or structural anomalies. Maternal body mass index did not affect the detection rate in the current series. Stepwise logistic regression analysis showed that three independent variables affecting the detection rate were complexity of the cardiac lesion, experience of the operator (tertiary scan), and the detection of other chromosomal anomalies. Conclusion: The public needs to be educated on the limitations of antenatal screening for congenital heart anomalies, especially on isolated septal defects. To improve future detection rates, further emphasis on the training and supervision of the sonologists needs to be stressed.