Short-term outcome of isolated and associated congenital heart defects in relation to antenatal ultrasound screening


Objective To investigate the outcome of fetuses affected by congenital heart defects (CHD), either detected or
undetected at ultrasound screening, according to their complexity and severity.
Design The study group comprised 3633 malformed fetuses entered into the Eurofetus database of which 798 had CHD. We compared the short-term outcome in
cases where a CHD was detected by ultrasound screening with that in cases where a CHD was not detected.
Isolated and associated CHD (ICHD and ACHD) and the degree of severity of defects were considered separately.
Outcome data included termination of pregnancy (TOP), intrauterine fetal death, neonatal death (<6 days after
birth), gestational age at diagnosis and at delivery, mode of delivery and birth weight.
Results Of the 798 fetuseswith CHD, 595 had ICHDand 203 had ACHD. The diagnosis of an anomaly was made significantly earlier in ACHD cases. TOP was chosen
in 28% of cases with a prenatal diagnosis of CHD, 20% for ICHD and 37% for ACHD (P < 0.001). The survival rate of antenatally diagnosed fetuses was lower in
those with ACHD than in those with ICHD (P < 0.001) and lower for fetuses with antenatal diagnosis than with postnatal diagnosis (P < 0.001); this was due to significant
differences in the complexity and severity of the defect.Premature delivery (<32 weeks) was more frequent in fetuses in which an antenatal diagnosis of CHD had
been made. Severe CHD were diagnosed earlier and were associated with a higher rate of TOP and spontaneous loss.
Conclusions The severity of CHDhas a positive influence on the sensitivity of screening but a negative influence on
the outcome. CHD that are not diagnosed antenatally include a high proportion of benign malformations. This explains the apparent paradox of a poorer outcome in
fetuses in which a CHDwas detected prenatally compared to those fetuses in which the defect was undetected prenatally. However, prenatal diagnosis provides parents
with the option of TOP or of preventive care in specialized centers.


Authors & affiliation: 
S. LEVI*, W. H. ZHANG†, S. ALEXANDER†, P. VIART‡, H. GRANDJEAN§ and THE EUROFETUS STUDY GROUP¶ *Eurofetus Project Leader, Brussels, †Ecole de Sant´e Publique, Universit´e Libre de Bruxelles, Brussels, ‡Clinique de Cardiologie P´ediatrique et Cong´enitale, Hˆ opital Universitaire des Enfants Reine Fabiola, Universit´e Libre de Bruxelles, Brussels, Belgium and §Inserm Unit 518, Hˆ opital La Grave, Toulouse, France (¶a complete list of the Eurofetus Study participating institutions is given in Reference 12)
Staff Members: 
Published In: 
Ultrasound Obstet Gynecol 2003; 21: 532–538
Publication date: 
Saturday, June 21, 2003