Fetal Cardiac Diagnosis and Its Influence on the Pregnancy and Newborn – A Tertiary Centre Experience

Abstract

Objectives: To evaluate the impact of an abnormal fetal cardiac scan on the management of the pregnancy and the outcome of the newborn. Methods: We reviewed all pregnancies that were referred to the Fetal Cardiac Unit for assessment to determine if the finding of a cardiac abnormality influenced the pregnancy and fetus, timing and mode of delivery, the treatment and outcome of the newborn. Diagnoses were confirmed by echocardiography following the baby’s delivery. Results: Between January 2005 and July 2006, there were 251 detailed fetal cardiac scans carried out on at risk pregnancies or those with suspected abnormal scans in 127 fetuses. Seven of the 92 mothers with abnormal fetal cardiac scans opted for termination. Two were successfully treated during the pregnancy for hydrops fetalis arising from a tachyarrhythmia. One was induced early because of deterioration of fetal well-being and increasing cardiac size. Twenty-six infants required a prostaglandin infusion prior to surgery. Two required intensive care for associated malformations. There were 24 survivors following complex surgery, and 2 deaths. Two infants with severe tricuspid valve incompetence from a dysplastic valve died, one associated with a septicaemia and the other where surgery was delayed because of prematurity and low birth weight. There was no maternal morbidity or mortality. Conclusions: Early detection of fetal cardiac malformation allows for careful counselling of the parents, ongoing antenatal review with a planned site and timing of delivery, and anticipatory postnatal care for optimum outcomes. The importance of careful screening is emphasized to allow for referral of mothers with potentially abnormal scans to an appropriate tertiary centre for confirmation and management.

Diagnosis and Treatment of Fetal Cardiac Disease

“…406 Counseling should be offered in temporal sequence shortly after the fetal echocardiogram, ideally on the same day. It should offer information on the nature of the specific diagnosis, with the practitioner providing an honest and truthful account of the findings.…”

Accuracy of Fetal Echocardiography in the Differential Diagnosis between Truncus Arteriosus and Pulmonary Atresia with Ventricular Septal Defect

“…It is well accepted that fetuses with a ductus-dependent CHD should be delivered in a center with a cardiology unit and that treatment with prostaglandins to maintain an optimal pulmonary blood supply via the DA should be started immediately after birth [5]. In our series, the DA was confirmed to be absent in the 9 necropsies from the CAT cases that underwent TOP as well as in case 7, in which a corrective surgery was performed on the 18th day of life.…”

“…The identification of a patent DA is a key criterion for establishing a correct differential diagnosis and to define perinatal management. It is generally accepted that a fetus with CAT can be delivered locally, whereas PA-VSD is a ductus-dependent cardiac defect and the affected fetus should ideally be born in a reference center with a cardiology unit where treatment with prostaglandins can be started immediately after birth [5]. On the other hand, the correct definition of the origin and characteristics of pulmonary blood supply is also highly relevant to adequately predict postnatal outcome, which will mostly depend on the possibility of reconstructing separated pulmonary and systemic circulations [6].…”

Performance of Different Scan Protocols of Fetal Echocardiography in the Diagnosis of Fetal Congenital Heart Disease: A Systematic Review and Meta-Analysis

“…The doctors can be informed clearly about the fetal heart function and the hemodynamics of fetal circulation. When the fetus meets restricted and harmful hemodynamics which could lead to abortion, her or his mother could receive immediately cesarean to terminate the continuous depravation of fetal condition [6], [130]–[132]. Regarding this point, it is important to make a definite and scientific diagnosis.…”

“…Many of them need surgical procedure in early life stage to retain their life [2]. In certain cases of fetal cardiac and other structural anomalies, prenatal diagnosis may be helpful or even life saving [3]–[5], with prenatal diagnosis providing optimal perinatal and perioperative management [6]. Fortunately, constant advance in ultrasound imaging has improved the imaging quality and the accuracy of earlier detection [7], [8].…”