Profile of Congenital Cardiovascular Anomalies among Stillborns at a Tertiary Care Hospital

Abstract

Introduction: Congenital cardiovascular anomalies refer to anatomic malformation of the heart and great vessels occurring during the intrauterine developmental process. Aim: To determine the pattern of distribution of cardiovascular anomalies through autopsy and to find an association between maternal factors and congenital anomalies, and also an association between autopsy and ultrasound findings. Materials and Methods: This was a descriptive cross-sectional study, which consisted of 50 stillborn foetuses. The foetuses were obtained from the Department of Obstetrics and Gynaecology at a JSS Medical College and Hospital, Mysuru, Karnataka, India. The foetus was fixed in 10% formalin and the autopsies were carried out as per standard foetal autopsy protocol. The cardiovascular anomalies were studied in detail. Data collected were entered in MS Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) version 22 to obtain relevant statistics. Descriptive measures like percentages were calculated and the distribution of birth weight, gestational age, maternal age, gravida of the mother, and socioeconomic status of parents among the stillborn foetuses were studied. Fisher’s-exact test was done to find out the association between maternal diabetes and cardiovascular anomalies. The results were interpreted as statistically significant at p<0.05. Results: Out of the total 50 stillborn foetuses studied, cardiovascular anomalies were present in five cases. The ventricular septal defect was the most common anomaly. Other anomalies were an atrial septal defect, tetralogy of fallot, and pulmonary stenosis. The occurrence of cardiovascular anomalies was four times more common in male foetuses than in the female. Each stillborn foetus was classified, based on birth weight, gestational age, maternal age, gravidity of the mother, and socioeconomic status of parents. Maximum foetuses 29 (58%) were having a birth weight between 500-1000 grams. Maximum foetuses 20 (40%) were from the gestational age group of 22-26 weeks. The maximum number of foetuses 24 (48%) were born to mothers in the age group of 26-30 years and 22 (44%) mothers were primigravida. The maximum number of stillborns 25 (50%) belonged to the lower middle class of socioeconomic status according to Kuppuswamy’s socioeconomic scale. History of consanguinity was present in 10 (20%) mothers. Fisher’s-exact test showed a significant association between maternal diabetes and cardiovascular anomalies (p<0.016). The autopsy confirmed the antenatal ultrasound findings in 40 (80%) of the cases. There were significant additional findings observed in 7 (14%) cases and ultrasound diagnosis was completely changed in 3 (6%) cases, after the final autopsy procedure. Conclusion: This study focuses on the importance of concomitant foetal autopsy in providing accurate genetic counseling. It is mandatory to have an autopsy study for all the stillborn foetuses to predict and counsel for safe future pregnancy outcomes. The preventive measures for maternal diabetes should be taken care of to avoid cardiovascular anomalies in the antenatal period and future pregnancies.