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

Abstract

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.

The vital role the ductus arteriosus plays in the fetal diagnosis of congenital heart disease: Evaluation by fetal echocardiography in combination with an innovative cardiovascular cast technology

“…Prenatal detection can improve the neonatal outcome by virtue of earlier surgical intervention [22,23] and less morbidity and mortality [24]. Furthermore, serial fetal echocardiograms are useful to evaluate evolving lesions thus making better the therapeutic outcomes [25].…”

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route

“…Results of sonographic screening programs for fetal cardiac anomalies increased prenatal detection rate from 35.8–59.7% in an international cohort. 8,9 Previous reports have grouped all types of fetal cardiac anomalies together for analysis with varying degrees of neonatal morbidity. 10 Botto et al 11 proposed a classification scheme for fetal cardiac anomalies incorporating cardiac defect type, cardiac complexity, and extracardiac anomalies.…”

Fetal Tricuspid Regurgitation in the First Trimester as a Screening Marker for Congenital Heart Defects: Systematic Review and Meta-Analysis

“…Antenatal ultrasound screening detects up to 60% of fetuses with CHD [5] . This means that a large proportion of CHD are not detected during the pregnancy [5] . Moreover, the detection of fetal CHD in the first trimester is even lower.…”