The Effect of Multidisciplinary Approach on the Birth Rate of Fetuses with Prenatally Diagnosed Congenital Heart Disease

Abstract

Background This study aimed to determine the effect of a multidisciplinary approach on the birth rate of fetuses with prenatally diagnosed congenital heart diseases (CHDs). Methods Among the fetuses of 724 gravidas who underwent fetal echocardiography in Samsung Medical Center from January 2013 to June 2017, 463 fetuses with normal cardiac structure, arrhythmia or simple left-to-right shunt were excluded, and the remaining 261 were included in the study. The subjects were subdivided into groups based on whether they were consulted multidisciplinarily, that is, consulted simultaneously by pediatric cardiologists, obstetricians and pediatric cardiac surgeons or not. They were also categorized based on the initial fetal echocardiogram results. Results Among the fetuses in the multidisciplinary group, 64.5% of the fetuses were given birth to, and the proportion was not different from that in the non-multidisciplinary group (68.6%, P = 0.48). The delivery rate in the multidisciplinary consultation group were 69.2% in the transposition of the great arteries group, 63.6% in the tetralogy of Fallot group, 68.8% in the pulmonary atresia or interrupted aortic arch group, 62.5% in the coarctation of aorta group, 60.0% in the atrioventricular septal defect group, 70.0% in the functional single ventricle group, and 55.6% in the hypoplastic left heart syndrome group; there were no significant differences between the 10 echocardiogram groups. However, when the subjects were categorized into Fontan repair group and biventricular repair group, the Fontan repair group showed a significant increase in the likelihood of delivery when a multidisciplinary approach was taken ( P = 0.035). Conclusion When a fetus was diagnosed with a CHD where Fontan repair should be considered, a multidisciplinary approach resulted in increased possibility of delivery.

A retrospective analysis of fetal heart defects in China: Investigating the influencing factors of pregnancy outcomes and evaluating the value of the multidisciplinary team cooperation approach

“…Multidisciplinary team counseling can help family members understand precisely and comprehensively the subtype, available management and treatment options, and the long-term prognosis of fetal heart abnormalities and facilitate decision-making [37][38][39]. In keeping with recent researches [21,40], our results con rmed the signi cant impact of a multidisciplinary team approach on the pregnancy outcomes of fetal cardiac defects. In comparing the pregnancy outcomes of patients with multidisciplinary team consultation and those without, we found that the MDT group has less termination rate, which suggests that the multidisciplinary team consultation is an effective strategy to provide authoritative prognosis counseling and perinatal management of fetal cardiac defects.…”

Impact of interdisciplinary counselling for parental decision-making in cases of pregnancies with prenatally diagnosed CHD

“…The fact that multi-disciplinary counselling that includes cardiac surgeons can influence the termination rate of pregnancies, particularly in the case of univentricular heart defects, has recently been described. 27…”

The challenges for macro talent management in the mature emerging market of South Korea: A review and research agenda

“…This fall in birth rate is a serious problem for Korea because the stabilization of fertility at such a low level inevitably results in accelerated population aging and depopulation (Seo, 2019). Despite the government's efforts to encourage childbirth, the low birth rate issue has not improved in Korea because of the aspirations of its working‐class women and residence pattern changes (Kim et al, 2019).…”