Status of Antenatal Detection of Congenital Heart Defects in a Northern Indian Population and Factors Influencing it

Abstract

Objective To evaluate the antenatal detection rate (ADR) of congenital heart defects (CHDs) in the northern part of India and also to assess the factors affecting the same.

Methods This was a prospective study performed at a tertiary referral center for pediatric cardiac care in northern India and included 200 consecutive infants (including neonates). A detailed history was obtained from the parents based on a protocol which included antenatal, birth and postnatal details including age at CHD detection. Patients with postnatal diagnosis of atrial septal defects, patent ductus arteriosus, partial anomalous pulmonary venous return, coronary and vascular ring anomalies and coarctation of aorta were excluded.

Results Median age of detection of CHD was 1 mo (range = 1 d–11 mo). Fetal echocardiography (FE) was done in 23 (11.5%) patients; CHD was detected in 21 of them, giving an overall antenatal detection rate (ADR) of CHD as 10.5%. Fifteen of them were referred to a pediatric cardiologist for FE while in 8 patients, FE was performed by sonologist or fetal medicine specialist. Median gestational age at referral to a regional pediatric cardiologist for FE was 24 wk (range = 18–36 wk). Most important factor affecting the ADR was total number of ultrasounds during pregnancy, with ADR being higher in those having four or more ultrasound examinations.

Conclusions Antenatal detection rate for CHD was very low. Referral for a focused fetal echocardiography during pregnancy is poor and those referred are done at very late stages of pregnancy. Measures that can help in improving the detection include following a strict protocol for cardiac screening, extending the screening to include the outflow tracts and early referral to fetal or pediatric cardiologists in case of minimal suspicion.

Keywords

Antenatal detection rate - Congenital heart defects - Fetal echocardiography

Publikationsverlauf

Eingereicht: 19. Februar 2017

Angenommen: 12. Juli 2017

Artikel online veröffentlicht:
08. Mai 2023