One year audit of a referral fetal echocardiography service.
OBJECTIVE
To perform a one year audit of a referral fetal echocardiography service.


METHODS
In 1992, 132 fetuses were referred for two dimensional fetal echocardiography, 40% being less than 24 weeks gestation. Validation of the accuracy of the fetal diagnosis by postnatal clinical or appropriate cardiac investigation was undertaken.


RESULTS
Indications for referral were a family history of congenital heart disease (n = 36), maternal indications, (40) suspected congenital heart disease on obstetric scan, (21) noncardiac fetal abnormality (19) and fetal arrhythmia. (16) The fetal echocardiogram was normal in 112, abnormal in 18 and not technically possible in two. The negative prediction of congenital heart disease was 96% accurate with four cases of congenital heart disease not diagnosed in utero. The positive prediction of congenital heart disease was 93% accurate with one false positive of a ventricular septal defect. The overall incidence of congenital heart disease was 17%. Four of 14 fetuses with major congenital heart disease had a chromosomal abnormality and five a coexistent noncardiac abnormality. The outcome of these 14 fetuses was poor, with three stillbirths, one termination of pregnancy, seven neonatal deaths and three only surviving beyond the neonatal period. Eleven of 21 cases referred with suspected congenital heart disease on obstetric scan were abnormal.


CONCLUSIONS
Detailed fetal echocardiography can predict significant congenital heart disease with a high degree of accuracy. Suspected cardiac abnormality on obstetric scans warrants referral for detailed fetal echocardiography, as do those considered at increased risk of congenital heart disease.
Cardiology Department, Green Lane Hospital, Epsom, Auckland.
N J
NJ
Wilson
B C
BC
Allen
P M
PM
Clarkson
D B
DB
Knight
A B
AB
Roberts
A L
AL
Calder
D005069:Evaluation Studies as Topic; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005318:Fetal Heart / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D009520:New Zealand; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016216:Ultrasonography, Prenatal / Q000592:standards / Q000706:statistics & numerical data*; D014600:Utilization Review