Prediction of outcome of fetal congenital heart disease using a cardiovascular profile score.
OBJECTIVE
Congestive heart failure in fetuses with congenital heart defects (CHD) is associated with high perinatal mortality. The clinical condition can be characterized by five ultrasound markers that comprise the 10-point cardiovascular profile (CVP) score. Our aim was to assess the value of the CVP score in evaluating the condition and in maintaining surveillance of fetuses with CHD.


METHODS
We evaluated retrospectively 131 singleton pregnancies with a diagnosis of fetal CHD, which had been assessed by serial echocardiographic examinations, during which the CVP score was obtained. Fetal and neonatal outcomes, including perinatal mortality and Apgar scores, were assessed.


RESULTS
Fetuses with a final CVP score <or= 7 were statistically significantly more likely to suffer mortality than were fetuses with a final CVP score >or= 8 (87.5% vs. 15.2% mortality; P < 0.0001, chi square = 24.5). Significance was maintained after controlling for birth weight, lag time between the final examination and delivery and the dichotomized 5-min Apgar score (odds ratio, 22.3; P = 0.024). For low Apgar score and mortality, the CVP score had low sensitivity (0.25 and 0.27, respectively) but high specificity (0.98 and 0.99, respectively). The presence of hydrops and severe cardiomegaly were statistically significantly associated with mortality (P < 0.05).


CONCLUSIONS
Fetuses with CHD and a CVP score below 8 are at risk of perinatal death. The CVP score may be used to assess the severity of fetal CHD and to plan perinatal management.
Wieczorek
A
A
Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL 33701, USA.
Hernandez-Robles
J
J
Ewing
L
L
Leshko
J
J
Luther
S
S
Huhta
J
J
D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005313:Fetal Death; D005316:Fetal Distress; D005323:Fetal Monitoring; D005500:Follow-Up Studies; D005865:Gestational Age; D006305:Health Status Indicators; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000196:embryology*; D006340:Heart Rate, Fetal; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*