Prenatal echocardiographic diagnosis of congenital heart disease in high-risk antenatal mothers in a tertiary care center and their postnatal outcome: An experience from third world

Abstract

Background: Congenital heart diseases (CHDs) are the most common fetal congenital defects, and until nowadays, most of them are bypassed without prenatal diagnosis. In this study, we found the incidence of fetal CHD in high-risk mothers, various indications of fetal echocardiography (FE), and their postnatal outcome in developing nation with limited resources. Materials and Methods: A total of 106 cases of antenatal mothers, who are having risk factors such as abnormal obstetric screening, diabetes mellitus, and family history, are included in the study group. The FE was done for pregnant mothers between the age groups of 20 and 40 years at different gestational ages after 20 weeks of pregnancy in the Postgraduate Department of Pediatrics, GMC, Srinagar, between January 2016 and January 2018. Results: The mean gestational age at diagnosis was 30.63 ± 4.3 weeks. The mean age of mothers at diagnosis was 29.99 ± 3.6 years. We identified indications for FE in 106 cases. The most common indication was abnormal cardiac findings in obstetrical screening sonography (30.18%). Among the 106 FE results, 80 (75.47%) were normal, eight (7.54%) were minor abnormalities, three (2.8%) were significant cardiac anomalies, eight (7.5%) were complex cardiac anomalies, and 60.7 (6.6%) were arrhythmias. The most common CHD was hypoplastic left heart syndrome (n = 4). Ninety-one neonates were examined by postnatal echo. We analyzed differences between FE and postnatal echo. There were minor differences in nine cases (9.89%) and major in only two (2.19%) cases. Transplacental fetal therapy was given in four cases. Two cases had fetal tachycardia that was reverted to sinus rhythm and two cases had complete heart block in which heart block persisted despite transplacental therapy. Conclusion: FE is a very useful tool for prenatal diagnosis of CHD. It has proven itself in the diagnosis and management of fetal arrhythmia, even in developing countries with limited resources.