Antenatal diagnosis of congenital heart disease and Down's syndrome: the potential effect on the practice of paediatric cardiology.
OBJECTIVE
To predict the effect of antenatal ultrasound screening for congenital heart disease and maternal serum screening of Down's syndrome on the practice of paediatric cardiology and paediatric cardiac surgery.


METHODS
A retrospective and prospective ascertainment of all congenital heart disease diagnosed in infancy in 1985-1991.


METHODS
One English health region.


METHODS
All congenital heart disease diagnosed in infancy by echocardiography, cardiac catheterisation, surgery, or necropsy was classified as "complex", "significant", or "minor" and as "detectable" or "not detectable" on a routine antenatal ultrasound scan.


RESULTS
1347 infants had congenital heart disease which was "complex" in 13%, "significant" in 55%, and "minor" in 32%. 15% of cases were "detectable" on routine antenatal ultrasound. Assuming 20% detection and termination of 67% of affected pregnancies, liveborn congenital heart disease would be reduced by 2%, infant mortality from congenital heart disease by 5%, and paediatric cardiac surgical activity by 3%. Maternal screening for Down's syndrome, assuming 75% uptake, 60% detection, and termination of all affected pregnancies, would reduce liveborn cases of Down's syndrome by 45%, liveborn cases of congenital heart disease by 3.5%, and cardiac surgery by 2.6%.


CONCLUSIONS
Screening for congenital heart disease using the four chamber view in routine obstetric examinations and maternal serum screening for Down's syndrome is likely to have only a small effect on the requirements for paediatric cardiology services and paediatric cardiac surgery.
Abu-Harb
M
M
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne.
Wyllie
J
J
Hey
E
E
Richmond
S
S
Wren
C
C
D006348:Cardiac Surgical Procedures; D002309:Cardiology; D004314:Down Syndrome / Q000175:diagnosis*; D004739:England; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit; D010372:Pediatrics; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography