Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1995 Aug;74(2):192–198. doi: 10.1136/hrt.74.2.192

Antenatal diagnosis of congenital heart disease and Down's syndrome: the potential effect on the practice of paediatric cardiology.

M Abu-Harb 1, J Wyllie 1, E Hey 1, S Richmond 1, C Wren 1
PMCID: PMC483998  PMID: 7547001

Abstract

OBJECTIVE--To predict the effect of antenatal ultrasound screening for congenital heart disease and maternal serum screening of Down's syndrome on the practice of paediatric cardiology and paediatric cardiac surgery. DESIGN--A retrospective and prospective ascertainment of all congenital heart disease diagnosed in infancy in 1985-1991. SETTING--One English health region. PATIENTS--All congenital heart disease diagnosed in infancy by echocardiography, cardiac catheterisation, surgery, or necropsy was classified as "complex", "significant", or "minor" and as "detectable" or "not detectable" on a routine antenatal ultrasound scan. RESULTS--1347 infants had congenital heart disease which was "complex" in 13%, "significant" in 55%, and "minor" in 32%. 15% of cases were "detectable" on routine antenatal ultrasound. Assuming 20% detection and termination of 67% of affected pregnancies, liveborn congenital heart disease would be reduced by 2%, infant mortality from congenital heart disease by 5%, and paediatric cardiac surgical activity by 3%. Maternal screening for Down's syndrome, assuming 75% uptake, 60% detection, and termination of all affected pregnancies, would reduce liveborn cases of Down's syndrome by 45%, liveborn cases of congenital heart disease by 3.5%, and cardiac surgery by 2.6%. CONCLUSIONS--Screening for congenital heart disease using the four chamber view in routine obstetric examinations and maternal serum screening for Down's syndrome is likely to have only a small effect on the requirements for paediatric cardiology services and paediatric cardiac surgery.

Full text

PDF
198

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abu-Harb M., Hey E., Wren C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child. 1994 Jul;71(1):3–7. doi: 10.1136/adc.71.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Achiron R., Glaser J., Gelernter I., Hegesh J., Yagel S. Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies. BMJ. 1992 Mar 14;304(6828):671–674. doi: 10.1136/bmj.304.6828.671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ades A. E. Evaluating screening tests and screening programmes. Arch Dis Child. 1990 Jul;65(7):792–795. doi: 10.1136/adc.65.7.792. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bound J. P., Logan W. F. Incidence of congenital heart disease in Blackpool 1957-1971. Br Heart J. 1977 Apr;39(4):445–450. doi: 10.1136/hrt.39.4.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bromley B., Estroff J. A., Sanders S. P., Parad R., Roberts D., Frigoletto F. D., Jr, Benacerraf B. R. Fetal echocardiography: accuracy and limitations in a population at high and low risk for heart defects. Am J Obstet Gynecol. 1992 May;166(5):1473–1481. doi: 10.1016/0002-9378(92)91622-h. [DOI] [PubMed] [Google Scholar]
  6. Connor M. Biochemical screening for Down's syndrome. BMJ. 1993 Jun 26;306(6894):1705–1706. doi: 10.1136/bmj.306.6894.1705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Copel J. A., Pilu G., Green J., Hobbins J. C., Kleinman C. S. Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view. Am J Obstet Gynecol. 1987 Sep;157(3):648–655. doi: 10.1016/s0002-9378(87)80022-4. [DOI] [PubMed] [Google Scholar]
  8. Cullen S., Sharland G. K., Allan L. D., Sullivan I. D. Potential impact of population screening for prenatal diagnosis of congenital heart disease. Arch Dis Child. 1992 Jul;67(7 Spec No):775–778. doi: 10.1136/adc.67.7_spec_no.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Haddow J. E., Palomaki G. E., Knight G. J., Williams J., Pulkkinen A., Canick J. A., Saller D. N., Jr, Bowers G. B. Prenatal screening for Down's syndrome with use of maternal serum markers. N Engl J Med. 1992 Aug 27;327(9):588–593. doi: 10.1056/NEJM199208273270902. [DOI] [PubMed] [Google Scholar]
  10. Hoffman J. I., Christianson R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol. 1978 Oct;42(4):641–647. doi: 10.1016/0002-9149(78)90635-5. [DOI] [PubMed] [Google Scholar]
  11. Mitchell S. C., Korones S. B., Berendes H. W. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation. 1971 Mar;43(3):323–332. doi: 10.1161/01.cir.43.3.323. [DOI] [PubMed] [Google Scholar]
  12. Sharland G. K., Allan L. D. Screening for congenital heart disease prenatally. Results of a 2 1/2-year study in the South East Thames Region. Br J Obstet Gynaecol. 1992 Mar;99(3):220–225. doi: 10.1111/j.1471-0528.1992.tb14503.x. [DOI] [PubMed] [Google Scholar]
  13. Smythe J. F., Copel J. A., Kleinman C. S. Outcome of prenatally detected cardiac malformations. Am J Cardiol. 1992 Jun 1;69(17):1471–1474. doi: 10.1016/0002-9149(92)90903-c. [DOI] [PubMed] [Google Scholar]
  14. Wald N. J., Kennard A., Densem J. W., Cuckle H. S., Chard T., Butler L. Antenatal maternal serum screening for Down's syndrome: results of a demonstration project. BMJ. 1992 Aug 15;305(6850):391–394. doi: 10.1136/bmj.305.6850.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wald N. J., Kennard A. Prenatal biochemical screening for Down's syndrome and neural tube defects. Curr Opin Obstet Gynecol. 1992 Apr;4(2):302–307. [PubMed] [Google Scholar]
  16. Wyllie J., Wren C., Hunter S. Screening for fetal cardiac malformations. Br Heart J. 1994 Apr;71(4 Suppl):20–27. doi: 10.1136/hrt.71.4_suppl.20. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES