Improved Prenatal Detection of Congenital Heart Disease in an Integrated Health Care System

Abstract

The reported prenatal detection rates (PDRs) for significant congenital heart disease (sCHD) have been suboptimal, even in the current era. Changes in prenatal ultrasound policy and training may lead to improved prenatal detection of sCHD. This study analyzed the results of a policy to assess fetal cardiac outflow tracts shown by screening prenatal ultrasound using the electronic medical record (EMR). During a 6-year period, fetuses and patients younger than 1 year with sCHD were identified. The EMR was used to gather detection and outcome data. As an internal control within the same health care system, the PDR of only the surgical cases was compared with that of a similar group in which documentation of the fetal cardiac outflow tracts was not standard policy. Among 25,666 births, sCHD was identified in 93 fetuses or patients, yielding an incidence of 3.6 per 1,000 births. The PDR was 74.1%. Detection after birth but before discharge was 20.4%, and detection after discharge was 5.4%. A significant improvement in the PDR of sCHD was found when a concerted effort was made to obtain fetal cardiac outflow tract views during pregnancy screening (59.3 vs. 28%). Within an integrated health care system and with the use of an EMR, a PDR of 74% can be obtained, and 94% of sCHD can be detected before discharge. A concerted program that includes documentation of fetal cardiac outflow tracts in the pregnancy screening can result in improved PDR of sCHD.

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

“…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. Their study cohort was, however, rather small.…”

“…24 The total birth prevalence that was found in this study is consistent with a worldwide accepted birth prevalence of severe CHD. 2,7,10,25 Pathology databases, sudden infant death records and emergency ward admissions were studied for potential cases and we assume that we did not miss a significant number of them. The lost-to-follow-up rate in our cohort is very low.…”

“…[1][2][3][4] About 20-30% of these heart defects are severe, defined as being potentially life threatening and requiring surgery within the first year of life. 2,[5][6][7] Only 10% of CHD cases occur in pregnancies with identifiable risk factors, such as fetal extracardiac malformations. 8,9 The current screening strategy in most western countries is a standard anomaly scan at 20 weeks of gestation.…”

“…8 Although the prenatal detection rate of CHD has improved in the last decades, 5,10 the reported detection rate in low-risk populations does not exceed 35-40%. 7,[10][11][12][13][14] Prenatal detection of specific types of CHD may reduce neonatal mortality and morbidity. [15][16][17][18][19] It allows for planning the delivery at a tertiary-care centre ensuring optimal neonatal and perisurgical care.…”

Prenatal Counseling and Care for Single-Ventricle Heart Disease: One Center’s Model for Care

“…4 Similarly, recognition of complex CHD in the prenatal period is higher at tertiary care centers than at centers based in the community. 1,5 In a recent study, 6 the prenatal detection rate for significant CHD was as high as 74.1% when views of cardiac outflow tracts were documented on prenatal ultrasound. Obstetric screening guidelines have improved, and in 2013, they were modified to include outflow tract imaging as a standard part of the evaluation.…”