No abstract

No abstract

At 35 weeks gestation a 32 year old G1P0 woman presented with abnormal FHR late decelerations and abnormal fetal imaging showing severe right ventricular hypertrophy. She had been taking high doses of acetaminophen for symphysis pubis pain 10-12 doses of 500 mg per day for over 8 weeks. Fetal echo was performed in labour and delivery and showed no congenital heart defect and near occlusion of the ductus arteriosus

Objectives: Search the capacity for improvement based on the audit and prospective analysis of the diagnostic rate and its impact on healthcare quality. Methods: Tertiary national health hospital, the only for a 1 million inhabitants population. Centralisation of second trimester screening 20-22w ultrasound, 100% reach unselected population. Fetal malformations are scheduled for follow-up or TOP; explorers are certified; ultrasound methodology according to ISUOG guidelines; system: GE Voluson 730 Expert; all images are stored on hospital server. Data is collected daily in a congenital malformations registry, which is analysed prospectively and weekly on a Multidisciplinary Perinatological Committee, accredited by the Hospital. Accurate knowledge of false-negatives and true-positives, as well as evolution of the newborn. Results: Between 2014-2019, annual average of 7,189 scans was performed. 1,872 abnormal fetuses were diagnosed (4.7%). 98% were confirmed postnatally/autopsy. Found 73 false-negatives. Sensitivity 98.9%, specificity 99.8%, PPV 98% and NPV 99.7%. The most frequent are heart disease (61.2%, N = 1147) and CNS (16.5%, N = 308). These detailed data were the key to create both cardiology and neurology fetal and perinatal multidisciplinary committees (obstetrician, radiologist, pediatrician, pathologist, geneticist, along with a cardiologist, cardiac surgeon or neurologist), scheduling monthly sessions. There were 270 ILE (14, 4%),a decrease of 50% that exists in 2013. Conclusions: Continuous and prospective auditing, monitoring the false positives and negatives in heart and NCS diseases makes possible:

No abstract