ArticlesCurrent and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK*
Introduction
The feasibility of ultrasonography for diagnosis of fetal cardiac abnormality was recognised in the early 1980s,1, 2 and cardiac scanning is gradually being incorporated into fetal screening protocols. The effect of the screening process on the incidence and types of congenital heart disease at term has been difficult to ascertain because many pregnant women and infants travel great distances to specialist centres which are far from their health authority. For a single centre, the geographical area from which its fetal referrals arrive is generally not the same as the area attracting postnatal referrals, and the number of births that each serves is impossible to define. The British Paediatric Cardiac Association (BPCA) undertook a national collaborative study of fetal cardiac screening. The aim was to assess the effect of fetal diagnosis of congenital heart disease on the pattern of serious congenital heart disease at term.
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Methods
The treatment of serious congenital heart disease in infants and children is centralised; 13 centres in England, one in Wales, two in Scotland, and one in Northern Ireland carry out surgery and interventional catheter procedures on children. Data collection represented a national collaboration between members of the BPCA, who manage all these infants. Members of the BPCA submitted lists of all infants with serious congenital heart disease seen at the centres between 1993 and 1995; serious
Results
In the dataset there were 4799 affected pregnancies, 4165 babies born alive, 1124 fetal diagnoses, and 567 termination of pregnancy because the fetus had heart disease.
For the 1124 fetuses in whom the congenital heart disease was detected before birth, the duration of gestation when the problem was first recognised was before 22 weeks in 52% and after 28 weeks in 13%. Of these 1124 fetuses, 44% were subsequently born alive and 6% died spontaneously in utero. Thus, the overall termination rate
Discussion
Our inclusion criteria reflect an interest in major abnormalities with demands on emergency and inpatient paediatric cardiology services. By this definition, our results show that an obstetric centre with 3000 deliveries per year would expect to deal each year with 6·3 pregnancies affected by such disorders. Many of the published studies on the incidence of congenital heart disease suggest a higher incidence at term than documented in our study,8 but published figures can be inflated by the
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Congenital heart disease diagnosis: routine screening, fetal echocardiography and precision medicine
2023, Revista Medica Clinica Las CondesInitial national investigation of the prenatal diagnosis of congenital heart malformations in Japan-Regional Detection Rate and Emergency Transfer from 2013 to 2017
2021, Journal of CardiologyCitation Excerpt :A systematic approach based on a common protocol for prenatal diagnosis, by establishing a nationwide social system for prenatal diagnosis, increases DR for CHDs. The UK has developed a public cardiac screening system for fetuses under the control of the National Health Service after national surveillance for DR and serious CHD [8]. The Netherlands has improved its DR from 0.36 to 0.60 by a nationally organized screening program [9].
Special statement: Proposed quality metrics to assess accuracy of prenatal detection of congenital heart defects
2020, American Journal of Obstetrics and Gynecology
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Members listed at end of paper