Abstract 11221: Counseling in the Time of COVID - Prenatal Diagnosis of Congenital Heart Disease During a Pandemic

Abstract

Introduction: Comprehensive prenatal care of congenital heart disease (CHD) relies on a multi-disciplinary approach that includes timely prenatal counseling and individualized care plans for the pregnancy, delivery and neonatal period. With the COVID-19 pandemic our fetal therapy clinic (FTC) approach to patient care was altered to accommodate restrictions, including the use of telehealth visits. We investigated whether counseling and access to care for fetal patients with CHD was negatively impacted by COVID-19. Hypothesis: Fetuses with CHD would experience a delay in timing of diagnosis and referral; parents would receive a shorter counseling session during the COVID-19 pandemic. Methods: Retrospective chart review of all fetal cardiology patients seen in our multidisciplinary FTC both before (5/1/19-12/31-19) and during the COVID-19 pandemic (5/1/20-12/31/20). Data collected included gestational age (GA) at referral, GA at first fetal echo, use of telehealth, total time counseled, number of sub-specialty consults, and total number of fetal cardiology visits. Results: A comparable number of dyads were seen before and during the pandemic (Table 1). GA at initial diagnosis was similar, but GA at referral and first visit was earlier during the pandemic. Additionally, families seen during the pandemic had longer counselling across all disciplines with significant differences in pediatric cardiology and neonatology. There was no difference in total number of consults or access to care based on insurance. Conclusions: While prenatal counseling and referral to FTC is multifaceted, we demonstrated that COVID-19 and alterations in care delivery did not in fact lead to delays in referrals for patients across a large geographical catchment. Moreover, with telemedicine we were able to ensure our families continued to receive multidisciplinary care and families were able to spend more time with our care team developing comprehensive individualized plans.

Update on Prenatal Detection Rate of Critical Congenital Heart Disease Before and During the COVID-19 Pandemic

“…While we had anticipated that such conditions would impact the ability of patients to receive ultrasound examinations and attend echocardiography referral appointments, leading to decreased quality of prenatal care and missed fetal cardiac screening opportunities, we postulate that this continued uptrend in prenatal diagnosis rates may have been augmented by successful COVID-19 accommodations within obstetric care as well as more comprehensive screening recommendations by multiple society guidelines. Several recent studies of prenatal care during the pandemic have suggested equal or even improved prenatal care utilization, including increased rates of initiation of prenatal care in the first trimester, unchanged numbers of total prenatal care visits, and equal-to-increased number of dating and anatomy ultrasound examinations [ 18 – 20 ]. One preliminary study that examined prenatal diagnosis of CHD at a single-center fetal therapy clinic that had implemented increased use of telehealth specifically found that patients had a similar gestational age at initial diagnosis of CHD, an earlier gestational age at referral and first visit, and longer pediatric cardiology counseling [ 20 ].…”

“…Several recent studies of prenatal care during the pandemic have suggested equal or even improved prenatal care utilization, including increased rates of initiation of prenatal care in the first trimester, unchanged numbers of total prenatal care visits, and equal-to-increased number of dating and anatomy ultrasound examinations [ 18 – 20 ]. One preliminary study that examined prenatal diagnosis of CHD at a single-center fetal therapy clinic that had implemented increased use of telehealth specifically found that patients had a similar gestational age at initial diagnosis of CHD, an earlier gestational age at referral and first visit, and longer pediatric cardiology counseling [ 20 ]. This was postulated to be due to the ability for patients to develop more comprehensive and individualized care plans with their care team via the flexibility of telemedicine appointments.…”