Prenatal Detection of Congenital Heart Diseases: One-Year Survey Performing a Screening Protocol in a Single Reference Center in Brazil

Abstract

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.” Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% (n = 13) of “complex” cases, 18.5% (n = 5) “significant” cases, and 7.4% (n = 2) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases.

Risk Factors for Mortality in Children with Congenital Heart Disease Delivered at a Brazilian Tertiary Center

“…Similar to previous studies, we established that the postnatal incidence of CHD is high at our center [21,22] possibly due to the absence of laws that facilitate the interruption of gestation in Brazilian patients with CHD [9,15,17] . Moreover, patients are referred to a tertiary center after prenatal diagnosis, thereby increasing the incidence of CHD at our institute.…”

“…A comprehensive assessment of the fetal heart optimizes the diagnosis of CHD, offering appropriate prenatal and postnatal planning and facilitating an improvement in neonatal morbidity and surgical outcome [10,12-17] . Newborns with postnatal diagnosis could have unfavorable outcomes because symptoms and cardiovascular impairment may develop at home or in a community hospital, further increasing the morbidity and mortality rates.…”

Fetal Echocardiography as a Screening Method for Detection of Congenital Heart Disease

“…Our results in the high-risk group did not agree with the results of a study conducted by Rocha et al (24) who showed that the incidence of CHD in fetuses was 9.9%, their study population were pregnant women who were referred for suspicion or with some risk of CHD.…”

Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio‐Temporal Image Correlation in the Second and Third Trimesters of Pregnancy

“…We also observed the prevalence of advanced maternal age in this studied population. This factor can be explained by high‐risk population referred to our service, since 40.4% of pregnant women from this institution are >35 years of age . Advanced maternal age is a characteristic in several studies of CHD …”

“…This factor can be explained by high-risk population referred to our service, since 40.4% of pregnant women from this institution are >35 years of age. 23 Advanced maternal age is a characteristic in several studies of CHD. 16,24 Current literature shows that the highest rate of indication for screening of CHD consists of changes in nuchal translucency, fetal death in a previous pregnancy, or the suspicion of a fetal abnormality in a prior ultrasound examination.…”