title: Fetal heart disease: severity, associated anomalies and parental decision.
abstract: OBJECTIVE
  This study describes the association between the complexity of congenital cardiac and extracardiac malformations, and the parental decision of pregnancy continuation or termination.
  
  
  METHODS
  Congenital heart defects (CHD) was diagnosed by ultrasound in 251 fetuses before the 24th week (23 + 6 weeks) of gestation during the four year period from 2007 to 2010. All fetuses from the Utrecht region were referred to our center due to a strict referral pattern. The complexity and severity of the cardiac and possible extracardiac malformations were retrospectively categorized by a pediatric cardiologist and a perinatologist who were blinded to the pregnancy outcome. The groups with and without termination of pregnancy were compared using a univariate analysis and multivariate logistic regression.
  
  
  RESULTS
  In 119 (47%) of the 251 fetuses, parents opted for termination of pregnancy. In 103 of these cases (87%) there was a high complex or lethal cardiac, or a major or lethal extracardiac malformation. Of the 132 continued pregnancies, 42 fetuses (32%) had a high complex or lethal cardiac, or a major or lethal extracardiac malformation. There were significantly more terminations of pregnancy in case of a high or lethal complex cardiac or extracardiac anomaly (71 vs. 15%, p <0.001).
  
  
  CONCLUSIONS
  Parents opted for termination of pregnancy significantly more often in cases with high complex cardiac and extracardiac malformations. It was rare for parents to opt for pregnancy termination in the absence of a severe cardiac or extracardiac malformation.
authors.affiliation: Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Nell
authors.forename: Camiel A
authors.initials: CA
authors.lastname: Wijngaarde
authors.forename: Lourens R
authors.initials: LR
authors.lastname: Pistorius
authors.forename: Martijn
authors.initials: M
authors.lastname: Slieker
authors.forename: Henriette
authors.initials: H
authors.lastname: ter Heide
authors.forename: G T R
authors.initials: GT
authors.lastname: Manten
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Freund
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000025:Abortion, Eugenic; D000328:Adult; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D009426:Netherlands; D010290:Parents; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal