Objective To review the indication and outcome of pregnancies referred to our Fetal Cardiac Service.

Methods Retrospective review of consecutive referrals for fetal echocardiography between 2006 and 2008.

Results 618 pregnancies (863 scans) were referred. 163 pregnancies were referred with a cardiac anomaly detected on routine obstetric scan. 413 pregnancies were identified as high risk for a fetal cardiac anomaly and referred for screening. 24/413 (6%) of women referred for screening had an abnormal fetal echocardiogram, five with a major cardiac anomaly. Risk factors identified were maternal (23%), familial (50%) and fetal (25%).

Of 163 cases referred with an already suspected cardiac anomaly 26 (16%) had one or more high risk factors. 24/26 in ‘high risk subgroup’ had major cardiac anomalies.

Indication for 42 referrals unknown or inappropriate.

Conclusion At our Fetal Cardiac Service the number of antenatally diagnosed cardiac defects detected during screening of high risk pregnancies is low. A significant proportion of this group have an abnormal fetal echocardiogram with varying clinical significance. It is gratifying that the majority of congenital heart defects in high risk pregnancies are detected during routine obstetric screening. We would expect obstetric ultrasound training and introduction of outlet views into routine scans, to increase antenatal diagnosis. How these changes are implemented and the implications for risk stratification for fetal cardiac screening policy will need to be evaluated in further studies.

At this time to ensure an increased detection rate all high risk pregnancies will continue to be referred to a specialist.