title: Fetal echocardiography assists in determining optimal delivery site.
abstract: OBJECTIVE
  Congenital heart disease is one of the most common types of structural fetal abnormalities and a major cause of perinatal morbidity and mortality. Fetal echocardiography aids in the diagnosis of congenital heart disease, which allows management planning for parents and physicians, including continuation or termination of the pregnancy and triaging for location of delivery. This is a key component of planning, as transport of neonates entails risks, costs, and parental stress. In this study, we examined the outcomes of pregnancies with fetal cardiac anomalies diagnosed at a single tertiary care centre. We aimed to assess whether the system of directing affected pregnancies to either a tertiary and quaternary care centre is effective.
  
  
  METHODS
  We identified pregnancies with fetal cardiac anomalies diagnosed on fetal echocardiography between 2005 and 2009. Information about diagnosis, pregnancy outcome, delivery location, and surgical management was collected. This information was analyzed retrospectively.
  
  
  RESULTS
  Anomalies were demonstrated in 120 fetal echocardiography studies. Four of the babies (3.3%) were stillborn, and 27 (22.5%) pregnancies were terminated. There were 89 live born babies, and 74 of these (61.7%) survived the neonatal period. Fifteen babies (12.5%) died as neonates. Thirty-two pregnant women were triaged to deliver at the quaternary centre with pediatric cardiac surgery services, and 20 of these babies underwent surgery. Two of the 89 live born babies (2.2%) required emergency transfer.
  
  
  CONCLUSIONS
  Fetal echocardiography is an important contributor to efficient use of pediatric cardiac services and minimizes need for neonatal transfer. Contemporary use of fetal echocardiography is associated with optimized delivery location.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton ON.
authors.forename: Anne
authors.initials: A
authors.lastname: Berndl
authors.affiliation: Women's Reproductive Health and Newborn Care Program, McMaster University, Hamilton ON.
authors.forename: Kelly
authors.initials: K
authors.lastname: Pearce
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton ON.
authors.forename: Tapas
authors.initials: T
authors.lastname: Mondal
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D063868:Patient Outcome Assessment; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology; D014187:Transportation of Patients; D014218:Triage; D014463:Ultrasonography
keywords: congenital heart defect; echocardiography; patient transfer; prenatal diagnosis; prenatal ultrasound