title: Prenatal detection of congenital heart disease--results of a national screening programme.
abstract: OBJECTIVE
  Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme.
  
  
  METHODS
  Geographical cohort study.
  
  
  METHODS
  Large referral region of three tertiary care centres.
  
  
  METHODS
  Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012.
  
  
  METHODS
  Cases were divided into two groups: before and after the introduction of screening.
  
  
  METHODS
  Detection rates were calculated.
  
  
  RESULTS
  The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3).
  
  
  CONCLUSIONS
  This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: van Velzen
authors.affiliation: Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Clur
authors.affiliation: Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: M E B
authors.initials: ME
authors.lastname: Rijlaarsdam
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bax
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: M N
authors.initials: MN
authors.lastname: Bekker
authors.affiliation: Department of Paediatric Cardiology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hruda
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.|Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: N A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Haak
mesh_terms: D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D015397:Program Evaluation; D011446:Prospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal
keywords: Congenital heart defects; detection rate; fetal echocardiography; prenatal anomaly screening; prenatal diagnosis