Abstract
Objective To evaluate the antenatal detection rate (ADR) of congenital heart defects (CHDs)
in the northern part of India and also to assess the factors affecting the same.
Methods This was a prospective study performed at a tertiary referral center for pediatric
cardiac care in northern India and included 200 consecutive infants (including neonates).
A detailed history was obtained from the parents based on a protocol which included
antenatal, birth and postnatal details including age at CHD detection. Patients with
postnatal diagnosis of atrial septal defects, patent ductus arteriosus, partial anomalous
pulmonary venous return, coronary and vascular ring anomalies and coarctation of aorta
were excluded.
Results Median age of detection of CHD was 1 mo (range = 1 d–11 mo). Fetal echocardiography
(FE) was done in 23 (11.5%) patients; CHD was detected in 21 of them, giving an overall
antenatal detection rate (ADR) of CHD as 10.5%. Fifteen of them were referred to a
pediatric cardiologist for FE while in 8 patients, FE was performed by sonologist
or fetal medicine specialist. Median gestational age at referral to a regional pediatric
cardiologist for FE was 24 wk (range = 18–36 wk). Most important factor affecting
the ADR was total number of ultrasounds during pregnancy, with ADR being higher in
those having four or more ultrasound examinations.
Conclusions Antenatal detection rate for CHD was very low. Referral for a focused fetal echocardiography
during pregnancy is poor and those referred are done at very late stages of pregnancy.
Measures that can help in improving the detection include following a strict protocol
for cardiac screening, extending the screening to include the outflow tracts and early
referral to fetal or pediatric cardiologists in case of minimal suspicion.
Keywords
Antenatal detection rate - Congenital heart defects - Fetal echocardiography
