Outcome of 274 Cases with Prenatal Diagnosis of Congenital Heart Disease: Multicenter Study of Korean Fetal Cardiology Study Group in 1998 / 대한주산의학회잡지

OBJECTIVE: Prenatal diagnosis of congenital heart disease(CHD) has been made by fetal echocardiography and its clinical impact on the outcome of affected cases has been reported. METHODS: A multicenter retrospective study was performed by our study group for the fetal diagnosis of CHD, confirmed postnatally or at second study and/or at autopsy and/or follow up. 274 cases out of 8 centers operating fetal echocardiography in high risk pregnancies were analyzed and their outcome was analyzed according to the presence of associated factors and with respect to the types of the CHD. RESULTS: There were 179 cases of significant CHD, 72 cases of miscellaneous CHD, 23 cases of fetal arrhythmias. Significant CHD consisted of 42 cases of ventricular septal defect(VSD), 17 cases of heterotaxia induding asplenia and polysplenia, 15 cases of complete atrioventricular septal defect(AVSD), 15 cases of coarctation of aorta, 14 cases of hypoplastic left heart syndrome(HLHS), 13 cases of tetralogy of Fallot(TOF), 11 cases of double outlet right ventricle(DORV). These 6 frequent CHDs consisted of 70.9% of significant CHD. The gestational age of the fetuses at diagnosis was 20-41 weeks(83 cases from 5 hospitals: Kangnam and Bundang CHA hospital, Ewha women's university hospital and Samsung medical center). 28.9%(24 out of 83 cases with known gestational age at diagnosis) had been diagnosed before 25 weeks of pregnancy. The most common indication of fetal echocardiography was abnormal obstetric ultrasound findings. Associated extracardiac and chromosomal anomaly was 27.9% and 11.7% respectively. The rate of termination of pregnancy(TOP)/significant CHD was 34.1%. Perinatal mortality was 39.7% induding 61 TOP, 5 fetal death in utero(FDIU), 4 neonatal death and 1 neonatal operative death. The most common factors of TOP were extracardiac and chromosomal anomaly. Five cases of d-transposition of great arteries with intact ventricular septum had been diagnosed prenatally at 3 hospitals, all of them had planned delivery and all survived arterial switch operation in the neonatal period. CONCLUSION: This study represents the impact of fetal echocardiograhpy on the outcome of CHD in Seoul and part of Kyung-Gi area in 1998. The data suggested that significant CHDs could be diagnosed accurately in most hospital But the prenatal detection rates of CHD were relatively low in several hospitil compared to the number of livebirth, probably due to inaccurate prenatal ultrasound screening.

The Value of Increased Nuchal Translucency(NT) for the Prediction of Abnormal Pregnancy Outcome / 대한주산의학회잡지

PURPOSE: To evaluate the NT in the first trimester associated with fetal chromosomal abnormality, fetal structural abnormality and adverse pregnancy outcome. METHODS: From Mar. 1993 to Dec. 1997, 133 cases of increased NT were reviewed retrospectively. All these fetues were taken a karyotyping and/or a high resolution ultrasonography for associated anomaly. The NT was measured by transvaginal ultrasonography(TVS) and transabdominal ultrasonography(TAS) if difficulty was encountered with TVS in the period of the 10th-14th week of gestation. The increased NT is approved when it is over 3mm. RESULTS: Of these 133 cases, 102 cases(76.7%) revealed normal outcomes and 31 cases(23.3%) revealed abnormal outcomes such as chromosomal abnormality, structural abnormality and adverse pregnancy outcome, The mean value of NT was 3.44+/-0.68mm in the normal group and 4.93+/-2.70mm in the abnormal group, respectively. The chromosomal abnormalities were found in 16 of the 31 cases: nine Down SD, two Patau syndrome, one Tuner synrome, one triploidy, one 46, XX,i(18q), one 47,iso(Xp)/46,XX one confined placental mosaicism. In 12 cases of the 31 cases, the structural anomalies were detected. Of these 12 cases, 3 cases were eventually developed to cytsic hygroma, 3 cases were cardiac anomaly, 3 cases were renal anomaly, 1 case was congenital diaphragmatic hernia, 1 case was skeletal dysplasia and 1 case was suspected syndrome. The adverse pregnancy outcome such as intrauterine growth restriction, intrauterine fetal death and preterm labor was revealed in 3 cases. In the cases of NT over 7mm, the result was 100% abnormal outcome. CONCLUSION: Increased NT in the first trimester could be a highly efficient the predictor for detection of chromosomal abnormality, structural anomaly and adverse pregnancy outcome.