母子保健クリニック

概要

Can we Improve the Perinatal Outcomes and Early Postnatal Survival of Fetuses with Congenital Heart Disease by Initiating Specialized Prenatal Consultation Service?

Yanji Qu, Jimei Chen, Fengzhen Han, Shao Lin, Erin M. Bell, Wei Pan, Teresa Huang, Yanqiu Ou, Shusheng Wen, Jinzhuang Mai, Zhiqiang Nie, Xiangmin Gao, Yong Wu, Emily Lipton, Richard G. Ohye, Jian Zhuang, Xiaoqing Liu

Background: Requirements of specialized prenatal consultation after prenatal diagnosis of Congenital Heart Disease (CHD) is increasing, but its impact is not clear. This study was to introduce such a specialized prenatal consultation service and assess its impact on outcomes of CHD fetuses.

Methods: We initiated specialized prenatal consultation in a referral tertiary cardiac center in southern China in 2013. A multidisciplinary team serves as consultants in this service and is especially responsible by two pediatric cardiologists in regular outpatient clinics. We included CHD fetuses diagnosed from 2011 to 2015 consecutively. They were divided into before (2011-2013) and after (2014-2015) specialized prenatal consultation groups and their perinatal outcomes, delivery location and early postnatal survival were compared. Risk factors for termination were also assessed.

Results: Totally, 1032 CHD fetuses were included and 533 accepted specialized prenatal consultation. After initiation of specialized prenatal consultation, the live birth rate significantly improved (OR=1.59, 95% CI: 1.10-2.29) and termination rate significantly reduced (OR=0.63, 95% CI: 0.44-0.91) in single CHD fetuses. No significant change in delivery location and postnatal survival of CHD fetuses were observed after specialized prenatal consultation. Referrals from district hospitals, along with multiple-lesion CHD, critical CHDs, gestational age<28 weeks at prenatal diagnosis were risk factors for termination.

Conclusion: Specialized prenatal consultation can improve the perinatal outcomes in single CHD fetuses. Education for district hospitals of standardizing counseling, especially for minor CHD fetuses and timely transferring of mothers with critical CHDs/multiple CHDs fetus is crucial to improve the outcomes of CHD fetuses further.