title: Barriers to prenatal detection of congenital heart disease: a population-based study.
abstract: OBJECTIVE
  To evaluate the extent and determinants of missed prenatal detection of congenital heart disease (CHD) in a population-based setting.
  
  
  METHODS
  This was a retrospective cohort study of cases with CHD, excluding minor defects, identified between 1997 and 2007 by a statewide surveillance program. We examined a comprehensive list of potential risk factors for which data were available in the surveillance database from abstracted medical charts. We analyzed the association of fetal, maternal and encounter factors with 1) whether a prenatal ultrasound was performed and 2) prenatal detection of CHD.
  
  
  RESULTS
  CHD was detected prenatally in only 39% of 1474 cases, with no improvement in detection rate over the 10-year period. Among the 97% (n = 1431) of mothers who underwent one or more ultrasound examinations, 35% were interpreted as abnormal; fetal echocardiography was performed in 27% of the entire cohort. Maternal and encounter factors increasing the adjusted odds of prenatal detection included: family history of CHD (OR, 4.3 (95% CI, 1.9-9.9)), presence of extracardiac defects (OR, 2.7 (95% CI, 1.9-3.9)) and ultrasound location i.e. high risk clinic vs clinic (OR, 2.1 (95% CI, 1.3-3.1)). Defects that would be expected to have an abnormal outflow-tract view were missed more often (64%) than were those that would be expected to have an abnormal four-chamber view (42%).
  
  
  CONCLUSIONS
  The majority of CHD cases over the 10-year study period were missed prenatally and detection rates did not increase materially during that time. The failure to detect CHD prenatally was related to encounter characteristics, specifically involving screening ultrasound examinations, which may be targeted for improvement.
authors: Division of Cardiology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Nelangi.Pinto@imail.org
authors: N M
authors: NM
authors: Pinto
authors: H T
authors: HT
authors: Keenan
authors: L L
authors: LL
authors: Minich
authors: M D
authors: MD
authors: Puchalski
authors: M
authors: M
authors: Heywood
authors: L D
authors: LD
authors: Botto
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011247:Pregnancy; D011264:Pregnancy Trimesters; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D014589:Utah / Q000453:epidemiology