Prenatal Ultrasound Misses CHD

Prenatal Ultrasound Misses CHD

Friedberg MK, Silverman NH, Moon-Grady AJ, et al. Prenatal Detection of Congenital Heart Disease. J Pediatr (July 2009); 155: 26-31. Full Text | Full-Text PDF (205 KB)

Study design. We prospectively identified all fetuses and infants ≤6 months of age with major CHD at 3 referral centers in Northern California over 1 year; we obtained prenatal and demographic data, reviewed prenatal ultrasound (US) and postnatal records, and used logistic regression to analyze maternal, fetal, and prenatal-care provider risk factors for prenatal diagnosis.

Results. Ninety-eight of 309 infants with major CHD had prenatal diagnosis (36% accounting for 27 pregnancy terminations); 185 infant-families participated in the postnatal survey, and although 99% had prenatal US, only 28% were prenatally diagnosed. Anomalous pulmonary venous return (0%), transposition of the great arteries (19%), and left obstructive lesions (23%) had the lowest prenatal detection. Heterotaxy (82%), single ventricle (64%), and HLHS (61%) had the highest. Prenatal diagnosis was higher at university versus community practices (P = .001). Sociodemographics were not associated with prenatal diagnosis. Infants diagnosed prenatally were less frequently ventilated (P < .01) or treated with prostaglandin (P < .05).

Conclusions. Prenatal detection of major CHD significantly alters postnatal course but remains low despite nearly universal US. CHD type and US practice type are important determinants of prenatal detection.

Comments. In this study, prenatal ultrasound studies done in University-based centers were 11x more likely to correctly diagnose congenital heart disease than community-based practices (p = 0.001). It looks like our community-based practices have a huge opportunity for improvement in the prenatal diagnosis of congenital heart disease (at least in the California community where this study was done). ABK

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