Impact of prenatal diagnosis of complex congenital heart disease on neonatal and infant morbidity and mortality

Chakraborty, Abhishek; Gorla, Sudheer R.; Swaminathan, Sethuraman

doi:10.1002/pd.5351

Cited by 47 publications

(56 citation statements)

References 31 publications

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“…Although only 1% of pregnant patients present a CHD, cardiac disease is the main cause of non-obstetric death in these patients. 9,10 The case reported by Gu et al in 2016 is similar to our case because their patient had a subaortic ventricular septal defect diagnosed in the adulthood and also she had an abortion. 18 Drenthen et al demonstrated that female patients with CCHD who received palliative heart surgery or those without any surgical management, therefore, 11% of cases develop heart failure and supraventricular tachyarrhythmias.…”

Section: Discussionsupporting

confidence: 84%

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Successful pregnancy in a patient with double outlet right ventricle

2020

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Background:The double outlet right ventricle is uncommon and usually makes patients have haemodynamic and structural complications. Having a hyperdynamic state, such as pregnancy, with volume overload is very risky for a patient with complex CHD (CCHD). The diagnosis in early stages can prevent cardiac complications. The multi-disciplinary assessment of the disease lets patients make choices in treatment and reproductive life.Objective:Present a case of a successful pregnancy in a patient with a rare CCHD.Participant:A pregnant 19-year-old patient with a double outlet right ventricle without haemodynamic or structural complications and no fetal abnormalities.

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Section: Discussionsupporting

confidence: 84%

“…9 Pregnancy patients with congenital cardiopathy should undergo a fetal echocardiogram between 18 and 22 weeks of gestational age. 10 The objective of this study is to present the case of a 19-year-old woman with a double outlet of the right ventricle who had 2 pregnancies.…”

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confidence: 99%

Successful pregnancy in a patient with double outlet right ventricle

2020

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“…Several studies have reported the beneficial impact of prenatal diagnosis and planned peri-partum care on peri-operative outcomes. [17][18][19][20][21][22] In fact, in most high-income countries, this has become the standard of care and prenatal screening of the fetal heart has been made a mandatory component of prenatal ultrasound protocols. 28 In developed countries, newborn cardiac screening using early physical examination and pulse oximetry screening are relatively well established, in contrast to low-middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Several studies from high-income countries have shown the beneficial impact of prenatal diagnosis of critical CHDs in improving peri-operative outcomes. [15][16][17][18][19][20][21][22] However, in low-middle-income countries, prenatal diagnosis of CHD is limited due to lack of awareness, trained personnel, and lack of implementation of standard protocols in the conduct of mid-trimester anomaly scans. 23 Prenatal diagnosis and planned peri-partum care of neonates with critical CHD might potentially emerge as complementary strategy to improving early postnatal diagnosis, stabilization, and transport.…”

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confidence: 99%

Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study

et al. 2019

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Background:Prenatal diagnosis and planned peri-partum care is an unexplored concept for care of neonates with critical CHDs in low-middle-income countries.Objective:To report the impact of prenatal diagnosis on pre-operative status in neonates with critical CHD.Methods:Prospective observational study (January 2017–June 2018) in tertiary paediatric cardiac facility in Kerala, India. Neonates (<28 days) with critical CHDs needing cardiac interventions were included. Pre-term infants (<35 weeks) and those without intention to treat were excluded. Patients were grouped into those with prenatal diagnosis and diagnosis after birth. Main outcome measure was pre-operative clinical status.Results:Total 119 neonates included; 39 (32.8%) had prenatal diagnosis. Eighty infants (67%) underwent surgery while 32 (27%) needed catheter-based interventions. Pre-operative status was significantly better in prenatal group; California modification of transport risk index of physiological stability (Ca-TRIPS) score: median 6 (0–42) versus 8 (0–64); p < 0.001; pre-operative assessment of cardiac and haemodynamic status (PRACHS) score: median 1 (0–4) versus 3 (0–10), p < 0.001. Age at cardiac procedure was earlier in prenatal group (median 5 (1–26) versus 7 (1–43) days; p = 0.02). Mortality occurred in 12 patients (10%), with 3 post-operative deaths (2.5%). Pre-operative mortality was higher in postnatal group (10% versus 2.6%; p = 0.2) of which seven (6%) died due to suboptimal pre-operative status precluding surgery.Conclusion:Prenatal diagnosis and planned peri-partum care had a significant impact on the pre-operative status in neonates with critical CHD in a low-resource setting.

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“…Timely detection of CHD has important advantages: it allows for close monitoring during pregnancy, planning the delivery in a centre with the required treatment facilities and it keeps the option of pregnancy termination open for the parents if the diagnosis is made before 24 weeks gestation. Prenatal diagnosis of CHD has shown to increase survival prior to planned cardiac surgery and decreases preoperative morbidity, especially in the case of ductal-dependent lesions 9 10…”

Section: Introductionmentioning

confidence: 99%

Prenatal diagnosis of a bundle branch block based on the fetal ECG

Noben¹,

Clur

Laar

et al. 2019

BMJ Case Rep

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A non-invasive fetal ECG was performed on a 36-year-old pregnant woman at 24+6 weeks of gestation as part of ongoing clinical research. A paediatric cardiologist suspected an incomplete bundle branch block based on the averaged ECGs from the recording. The characteristic terminal R’ wave was present in multiple leads of the fetal ECGs. A fetal anomaly scan had been performed at 20 weeks of gestation and showed no abnormalities. An incomplete right bundle branch block was confirmed on an ECG recorded at the age of 2 years. This case shows the possibility of novel non-invasive fetal ECG technology as an adjunct to the diagnosis of fetal cardiac anomalies in the future.

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Impact of prenatal diagnosis of complex congenital heart disease on neonatal and infant morbidity and mortality

Abstract: Prenatal diagnosis of complex CHD leads to improved preoperative morbidity, especially in patients with ductal-dependent cardiac anomalies. No survival benefits were noted with prenatal diagnosis of complex CHD.

Cited by 47 publications

References 31 publications

Successful pregnancy in a patient with double outlet right ventricle

Successful pregnancy in a patient with double outlet right ventricle

Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study

Prenatal diagnosis of a bundle branch block based on the fetal ECG

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