Fetal Heart Disease: Severity, Associated Anomalies and Parental Decision

Abstract

Objective: This study describes the association between the complexity of congenital cardiac and extracardiac malformations, and the parental decision of pregnancy continuation or termination. Methods: Congenital heart defects (CHD) was diagnosed by ultrasound in 251 fetuses before the 24th week (23 + 6 weeks) of gestation during the four year period from 2007 to 2010. All fetuses from the Utrecht region were referred to our center due to a strict referral pattern. The complexity and severity of the cardiac and possible extracardiac malformations were retrospectively categorized by a pediatric cardiologist and a perinatologist who were blinded to the pregnancy outcome. The groups with and without termination of pregnancy were compared using a univariate analysis and multivariate logistic regression. Results: In 119 (47%) of the 251 fetuses, parents opted for termination of pregnancy. In 103 of these cases (87%) there was a high complex or lethal cardiac, or a major or lethal extracardiac malformation. Of the 132 continued pregnancies, 42 fetuses (32%) had a high complex or lethal cardiac, or a major or lethal extracardiac malformation. There were significantly more terminations of pregnancy in case of a high or lethal complex cardiac or extracardiac anomaly (71 vs. 15%, p <0.001). Conclusion: Parents opted for termination of pregnancy significantly more often in cases with high complex cardiac and extracardiac malformations. It was rare for parents to opt for pregnancy termination in the absence of a severe cardiac or extracardiac malformation.

Associated genetic syndromes and extracardiac malformations strongly influence outcomes of fetuses with congenital heart diseases

“…We also showed that these associations were independent of the severity of the CHD, represented by defects unsuitable for biventricular repair. Our results were consistent with those of previous studies [15,17,19,20]. Russo et al showed that termination of pregnancy was [19].…”

“…Our results were consistent with those of previous studies [15,17,19,20]. Russo et al showed that termination of pregnancy was [19]. In our study, we decided to combine the cases of TOP and CC in the analysis, to assess the direct effect of cytogenetic anomalies and ECMs on parental choice to offer active treatment to their child, and on survival after active treatment.…”

Role of Health Insurance on the Survival of Infants With Congenital Heart Defects

“…If true, it be might be expected that this effect would be observed among only or more strongly for infants with critical CHDs, which were more likely to be detected prenatally. 36 Yet, the survival benefit in our study was present nearly equally among infants with critical and noncritical CHDs.…”

Prenatal and Preimplantation Diagnosis

“…(d) Factors that affect parental decision on TOP : The prenatal diagnosis of major structural abnormalities is one of the main reasons for termination of pregnancy (TOP) worldwide. The decision to continue or terminate the pregnancy has been associated primarily with the severity of the malformation (Asplin et al 2013 ;Nell et al 2013 ) but also with other factors like gestational age at diagnosis (Tararbit et al 2013 ), cultural issues, and the local legal status of TOP. Based on the EUROCAT registry, which provides useful data on overall impact of prenatal screening and testing, Garne et al ( 2005 ) reported on prenatal diagnosis of severe structural congenital malformations in Europe.…”