Impact of a regional training program in fetal echocardiography for sonographers on the antenatal detection of major congenital heart disease

McBrien, Angela; Sands, Andrew J; Craig, Brian; Dornan, James; Casey, Frank

doi:10.1002/uog.7616

Cited by 47 publications

(44 citation statements)

References 31 publications

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“…Uniform training, 35 and quality assessments of the ultrasonographers, warrant a quality level that is not restricted to urban areas only, as this cohort contains large rural areas as well. 29,36 A standardised educational programme for ultrasonographers, comparable to the one in the Netherlands, was described by Levy et al 7 They reached a prenatal detection rate of 74.1% within an integrated managed care consortium.…”

Section: Discussionmentioning

confidence: 99%

Prenatal detection of congenital heart disease—results of a national screening programme

Velzen

Clur

Rijlaarsdam

et al. 2015

BJOG

204

232

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Objective Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. Design Geographical cohort study. Setting Large referral region of three tertiary care centres. Population Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. Methods Cases were divided into two groups: before and after the introduction of screening. Main outcome measures Detection rates were calculated. Results The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5–28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0–26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the ‘late’ referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3–29.3). Conclusions This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.

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Section: Discussionmentioning

confidence: 99%

Prenatal detection of congenital heart disease—results of a national screening programme

Velzen

Clur

Rijlaarsdam

et al. 2015

BJOG

204

232

View full text Add to dashboard Cite

show abstract

“…In the UK, the best opportunity of screening for CHD is at the routine fetal anomaly ultrasound scan which is performed by radiographers with little experience and training in cardiac evaluation 1. Although training schemes have been shown to significantly improve prenatal detection of CHD, there is evidence that the beneficial effect diminishes with time 4 5 7. Effective screening for CHD may profit from additional strategies to provide ongoing support and opportunistic training for radiographers.…”

Section: Introductionmentioning

confidence: 99%

Fetal diagnosis of congenital heart disease by telemedicine

McCrossan

Sands

Kileen

et al. 2011

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objectives This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs). Setting A regional fetal cardiology unit and a district general hospital (DGH). Design A prospective study over 20 months. An initial FE was performed by a radiographer in the DGH (D1) followed by a second FE transmitted to the regional centre, in real time, via a telemedicine link with live guidance by a fetal cardiologist (D2). A FE was performed later at the regional centre (D3, reference standard). Structured questionnaires were employed to evaluate the technical quality of each tele-link and the radiographers' confi dence at performing FE. Results 69 remote FEs were performed and showed 58 normal hearts and 11 with congenital heart disease (CHD). D2 was accurate in 97% of cases compared with D3 (κ score=0.89) indicating excellent agreement. All tele-links connected at fi rst attempt with a mean study time = 13.9 min. Overall tele-link quality was rated highly (median=4/5). In 94% of tele-links, at least 11/12 components of the FE were confi dently assessed. The mean composite radiographer's questionnaire score increased signifi cantly during the study period (p<0.05). Conclusions To date this is the largest study of its kind. CHD can be confi dently diagnosed and excluded by remote FE. Radiographers report increased confi dence and profi ciency following involvement in real-time telemedicine. This application of telemedicine could improve access to fetal cardiology and support radiographers screening for CHD.

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“…We have become increasingly aware of the effect of these views on the developing fetal heart. Although we have not had any formal training program as in some studies 6 we have learned from each other and now train our junior staff and students accordingly.…”

Section: Resultsmentioning

confidence: 99%

2084998 A Review of The Diagnostic Accuracy of Fetal Cardiac Anomalies

Miceli

2015

Ultrasound in Medicine & Biology

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Objectives: In order to assess the diagnostic accuracy of fetal cardiac anomalies in our Department we undertook a retrospective analysis and compared our results with those of the paediatric cardiologists in the same cases. Methods: Sixty-five patients referred for second and third trimester fetal echocardiographic examinations were identified in our database from November 2005 to February 2014. Of these six scans were found to be normal by ultrasound and not referred on to the paediatric cardiologist. An additional six scans were diagnosed to have complex congenital heart disease (CHD) with or without extra cardiac abnormalities and/or aneuploidy. These six patients opted for termination of pregnancy and were also not seen by the paediatric cardiologist. The remaining 53 cases were referred to the paediatric cardiologist. Our results were analysed and then compared to the cardiologist's findings. There were an additional three cases scanned during the pregnancy in our department and diagnosed as normal but ultimately found in the neonatal period, to have CHD. Results:The ultrasound findings of the 53 cases scanned in our department were analysed and compared to the findings in the cardiologist's reports. The earlier scans tended to describe the abnormal anatomy but showed a reluctance to name any pathology. As training and confidence levels increased the less complex pathologies were correctly identified by our department and confirmed by the cardiologist. Conclusion: The skills, training and level of confidence required to diagnose fetal cardiac anomalies in our Department have improved over the eight years of the study period, particularly in regards to some of the less complex cardiac pathologies. However the more complex pathologies remain difficult to assess.

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Impact of a regional training program in fetal echocardiography for sonographers on the antenatal detection of major congenital heart disease

Abstract: Objectives The aims of this study were to ascertain the effect of a regional training program in fetal echocardiography for obstetric radiographers on the antenatal detection of major congenital heart disease (CHD) and to document short-term outcomes for major CHD. Methods

Cited by 47 publications

References 31 publications

Prenatal detection of congenital heart disease—results of a national screening programme

Prenatal detection of congenital heart disease—results of a national screening programme

Fetal diagnosis of congenital heart disease by telemedicine

2084998 A Review of The Diagnostic Accuracy of Fetal Cardiac Anomalies

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