Document Detail

Improving the effectiveness of routine prenatal screening for major congenital heart defects.
MedLine Citation:
PMID:  12231598     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the effectiveness of adding outlet views to the four chamber view in routine prenatal ultrasound screening for major congenital heart defects (CHD) as performed by trained sonographers, and to compare the procedure with current practice.
DESIGN AND SETTING: Prospective observational study at a London teaching hospital.
PARTICIPANTS AND METHODS: 9277 women booked at a single institution (80% had first trimester nuchal translucency measurement) due to have routine fetal cardiac screening using the four chamber and outflow tract views at > 18 weeks of gestation.
MAIN OUTCOME MEASURE: Identification of major CHD in chromosomally normal and abnormal pregnancies antenatally or postnatally.
RESULTS: There were 40 abnormalities (4.3/1000), of which 30 were chromosomally normal (3.3/1000). The overall antenatal detection rate was 75% (95% confidence interval (CI) 59% to 87%) and 70% (95% CI 51% to 85%) for euploid pregnancies. Abnormal cardiac views accounted for 70% of all prenatal diagnoses, 30% of which were made at < or = 18 weeks. The sensitivity of cardiac views during the first scan at > 18 weeks was 52%. Of all patients undergoing nuchal translucency screening, 34 had major CHD, nine with increased nuchal translucency (26.5%). Factors influencing the results of this screening programme were training and audit of operators, adequate equipment for antenatal examination, ease of access, and low threshold for referral to specialised fetal echocardiography.
CONCLUSION: Adding ventricular outlet views to the four chamber assessment of the heart at routine fetal anomaly scans at > 18 weeks is the most effective technique to detect CHD prenatally. The success of such a programme depends on an infrastructure committed to continuous in house training of obstetric ultrasonographers coupled with feedback from specialised fetal cardiologists, as well as adequate resource allocation to obstetric hospitals involved with antenatal screening.
J S Carvalho; E Mavrides; E A Shinebourne; S Campbell; B Thilaganathan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  88     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-09-16     Completed Date:  2002-10-28     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  387-91     Citation Subset:  AIM; IM    
Fetal Medicine Unit, St George's Hospital Medical School, London, UK.
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MeSH Terms
Chromosome Aberrations
Echocardiography / methods
Heart Defects, Congenital / genetics,  ultrasonography*
Prospective Studies
Referral and Consultation
Sensitivity and Specificity
Ultrasonography, Prenatal / standards*

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