Education in obstetrical ultrasound – an important factor for increasing the prenatal detection of congenital heart disease

Asplin, Nina; Dellgren, Annika; Conner, Peter

doi:10.1111/aogs.12140

Cited by 24 publications

(25 citation statements)

References 28 publications

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“…Nevertheless, their use has increased the likelihood of detecting d‐TGA in particular . The positive impact of training programmes on the success of antenatal cardiac screening has been widely acknowledged and there has been a general trend of increasing antenatal detection rates in well‐organised health systems …”

Section: Discussionmentioning

confidence: 99%

“…2 The positive impact of training programmes on the success of antenatal cardiac screening has been widely acknowledged and there has been a general trend of increasing antenatal detection rates in well-organised health systems. 14,15 The relationship between timing of diagnosis and survival is well recognised in the population of infants with congenital cardiac anomalies. 16,17 The effect of New Zealand's efforts to improve outcomes for those with cardiac anomalies through early detection is evident in this study.…”

Section: Discussionmentioning

confidence: 99%

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Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

et al. 2019

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Aim Assess the potential additional benefit from pulse oximetry screening in the early detection of critical congenital heart disease in a country with a well‐developed antenatal ultrasound screening programme. Methods Live‐born infants, pregnancy terminations and stillbirths from 20 weeks’ gestational age, between 2013 and 2015, with critical cardiac defects defined as primary or secondary targets of pulse oximetry screening were identified. Critical defects were those resulting in the death of a fetus or an infant in the first 28 days after birth, or a defect requiring intervention in the first 28 days. Results Two hundred and sixty‐eight infants and Fetuses were identified. Antenatal detection rates improved from 69% to 77% over the study period. An associated co‐morbidity improved antenatal detection rates. Twenty‐seven live‐born infants were diagnosed after discharge: 15 aortic arch obstruction (AAO); 10 d‐loop transposition of the great arteries (d‐TGA), and two total anomalous pulmonary venous drainage (TAPVD). Of these, five with AAO, nine with d‐TGA and likely both with TAPVD could potentially have been detected with oximetry screening. Conclusion The antenatal detection of critical cardiac anomalies continues to improve in New Zealand. Despite high antenatal detection rates for most lesions, universal postnatal oximetry screening has the potential to improve early detection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

et al. 2019

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“…This is likely a result of the rural location with greater isolation from peers and less ability to pursue further training in both image acquisition and interpretation. Training programs for those performing screening ultrasounds in the UK and Sweden have demonstrated a significant improvement in the detection of congenital heart disease . This improvement has been demonstrated with minimal investment of time, with some programs lasting only 1 to 3 days .…”

Section: Discussionmentioning

confidence: 99%

“…Training programs for those performing screening ultrasounds in the UK and Sweden have demonstrated a significant improvement in the detection of congenital heart disease. [21][22][23][24] This improvement has been demonstrated with minimal investment of time, with some programs lasting only 1 to 3 days. 23,24 Our data suggest that training programs in detection of CHD by screening obstetric ultrasound should be targeted to these impoverished, rural communities for the greatest impact.…”

Section: Figure 3 Prenatal Diagnostic Rate By View Required To Make Tmentioning

confidence: 99%

Disparities in the prenatal detection of critical congenital heart disease

et al. 2015

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Objectives Prenatal diagnosis of critical congenital heart disease, that requiring surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center which can reduce preoperative morbidity and mortality. We sought to identify risk factors for a missed prenatal diagnosis of critical congenital heart disease. Methods Patients presenting to the Children’s Hospital of Wisconsin with critical congenital heart disease from 2007-2013 were included. Those with a prenatal diagnosis were compared to those with a postnatal diagnosis. Results The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a 4 chamber view to make the diagnosis (p<0.0001), absence of another organ system anomaly (p<0.0001), and living in a higher poverty (p=0.02) or lower population density communities (p=0.002). Conclusions While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.

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“…Even physicians practicing in high‐risk settings have little knowledge about fetal cardiac‐screening guidelines and the sensitivity of screening views. Since physicians who interpret ultrasound studies represent multiple specialty and subspecialty fields with variations in training in cardiac imaging in the United States, the level of familiarity likely depends on individual interest . If the expected baseline of knowledge for image interpretation is standardized with well‐accepted guidelines for training and maintenance of expertise in obstetric ultrasound, detection should increase .…”

Section: Discussionmentioning

confidence: 99%

Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound

Pinto

Henry

Grobman

et al. 2019

J of Ultrasound Medicine

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Objectives-Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images.Methods-Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level.Results-Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04).Conclusions-Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.

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Education in obstetrical ultrasound – an important factor for increasing the prenatal detection of congenital heart disease

Cited by 24 publications

References 28 publications

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

Disparities in the prenatal detection of critical congenital heart disease

Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound

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