Elsevier

The Lancet

Volume 354, Issue 9186, 9 October 1999, Pages 1242-1247
The Lancet

Articles
Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK*

https://doi.org/10.1016/S0140-6736(99)01167-8Get rights and content

Summary

Background

Assessment of the effect of fetal diagnosis on the prevalence of congenital heart disease at term requires national ascertainment because referral patterns are not rigorously structured.

Methods

Between 1993 and 1995, all 17 paediatric cardiac centres in the UK submitted to a database lists of all fetuses diagnosed, and all infants needing surgery or interventional catheterisation or dying in the first year of life because of structural heart disease; details included the postal area of residence.

Findings

There were 4799 affected pregnancies, 4165 babies born alive, 1124 fetal diagnoses, and 567 terminations of pregnancy because the fetus had structural heart disease. Thus, a fetal diagnosis was made in 23·4% of affected pregnancies (11·7% of all affected livebirths) with geographical variability in diagnostic rates.

Interpretation

Fetal cardiac screening has an effect on the prevalence and types of congenital heart disease seen at term because many affected pregnancies are terminated. If detection rates of affected fetuses rose nationally to those seen in the 15 postal areas where detection rates were significantly higher than the national average in 1993–95, we would expect about 218 fewer affected individuals to be born annually.

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.

Section snippets

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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