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Change in referral and diagnostic trends in fetal cardiac screening over 7 years in south wales
  1. P N Gopalakrishnan,
  2. A Sinha,
  3. O Uzun
  1. University Hospital of Wales, Cardiff, UK


Aim To identify the reasons for referrals, foetal demise, termination of pregnancies in relation to foetal heart conditions, trend in yield rate and place of delivery.

Methods Retrospective review of all the tertiary foetal cardiology referrals in South Wales, UK from 2002 to 2008.

Results A total of 1744 mothers were referred for tertiary fetal cardiology assessment of which 1280 (73%) were normal. 442 (25%) of foetuses had confirmed cardiac anomalies.

Reasons for referral Structural heart anomalies-37%, associated congenital anomalies-9%,family history of congenital heart disease-22%,foetal arrhythmias-10%, maternal congenital heart disease-6%, increased nuchal thickness-15.5%.

Fetal demise Hypoplastic condition-31%, AVSD's-31%,tetrology of fallot-7%,outflow tract -left ventricular (3%),right ventricular(7%),ebsteins-7%, other conditions-14%.

Termination of pregnancies Hypoplastic conditions- 36%,AVSD's-23%,transposition of great arteries-11%,truncus arteriosus-5%,tetrology of fallor-4%, right sided -7%;left sided5% obstructive lesions.

Total yield rate (confirmed foetal cardiac anomaly)Increased from12%-2002,17%-2003,22%-2004,31%-2005,37%-2006,39%-2007 and 49%-2008.

Place of delivery 68% were delivered in tertiary cardiac centres,20% were delivered in neonatal intensive care centres and 12% were delivered in district general hospitals with high dependency neonatal support only.

Conclusions Structural heart anomalies and family history of congenital heart conditions were the main reasons for tertiary fetal cardiology assessment. Hypoplastic heart conditions and atrio ventricular septal defects were the main reasons for foetal demise and termination of pregnancies. Successful training of antenatal ultrasonographers in including outflow tract views in addition to the routine four chamber view led to increase in yield rate. Early identification of major congenital cardiac anomalies and counselling led to delivering in tertiary cardiac surgical centres.

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