P22.01: Fetal echocardiography and pregnancy outcome in Serbia

Abstract

To analyse the influence of fetal echocardiography on pregnancy outcome after prenatal diagnosis of congenital heart defects in tertiary institution in Serbia. This is the first and the largest study of this type in our country. We analysed 14500 fetal echocardiography exams in period 1991-2014 which were performed at Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia and University Children's Hospital in Belgrade. Obtained data was presented descriptively, by percentage and indicators of diagnostic accuracy: sensitivity and specificity. Among total of 9055 examined fetuses, pathological finding on the fetal heart was found in 638 cases. The most common congenital heart defects were structural anomalies of the fetal heart in 81%, of which 13.3% were HLHS and 11.2% VSD. Of all fetuses with diagnosed congenital heart defects, 295 (46.2%) were born alive and had good postnatal prognosis. In group of liveborn, the highest survival rate was observed in children with shunt defects (24%) and arrhythmias (33,5%). Fetal demise occurred in 17 (2.7%) of pregnancies. In early neonatal period died 68 (10.6%). Pregnancy was terminated in 40.4% cases with isolated severe congenital heart defects or in cases with concomitant fetal anomalies or chromosomopathies. Some sort of intervention was required in 110 fetuses (17,2%). Postnatal surgical correction of congenital heart disease underwent 75 (11,7%) neonates. Postoperatively died 9 (1,4%) neonates. Sensitivity of fetal echocardiography in our group was 95,92%, specificity 99,91%. Fetal echocardiography had high influence on pregnancy outcome in our study given the fact that Serbia is still country in transition with limited options for congenital heart defects treatment. Despite relatively high percentage of terminated pregnancies in cases with poor prognosis, good outcome was achieved in cases with correctible fetal heart defects.