Perinatal management of fetal cardiac anomalies in a specialized obstetric-pediatrics center.
Perinatal teams dealing with fetal heart disease frequently wonder which pregnancies might be terminated, and when delivery should take place in a specialized surrounding. We present a retrospective study of 229 fetuses, in which prenatal ultrasound showed a cardiac anomaly not compatible with a standard maternity ward delivery. One hundred nineteen pregnancies were terminated (group I) while 110 pregnancies led to the birth of a live baby (group II). Pathology in group I was discovered earlier than in group II (24 vs. 29.3 weeks' gestation; p <0.01), and associated malformations or chromosomal anomalies were much more frequent in group I (80/119 vs. 9/110; p <0.001). Among live born babies, three infants with transposition of the great arteries underwent Rashkind atrioseptostomy in the delivery room. With a minimum follow-up of 12 months, 69 children (63%) have undergone surgery. Among 92 survivors (1 child is lost to follow-up), 78 (71%) are asymptomatic and 14 symptomatic. Early prenatal diagnosis of fetal heart anomalies significantly facilitates prenatal work-up and perinatal care. We present the types of pathology having led to termination and define the situations in which children are at risk of perinatal hemodynamic compromise.
Mirlesse
V
V
Service de Médecine foetale, Institut de Puériculture, Paris, France.
Cruz
A
A
Le Bidois
J
J
Diallo
P
P
Fermont
L
L
Kieffer
F
F
Magny
J F
JF
Jacquemard
F
F
Levy
R
R
Voyer
M
M
Daffos
F
F
D000025:Abortion, Eugenic / Q000706:statistics & numerical data*; D002869:Chromosome Aberrations / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006330:Heart Defects, Congenital / Q000145:classification / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D018743:Perinatal Care / Q000458:organization & administration*; D010500:Perinatology / Q000706:statistics & numerical data; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014463:Ultrasonography