Fetal Heart Disease: Severity, Associated Anomalies and Parental Decision

• Published in: Fetal diagnosis and therapy Vol. 33; no. 4; pp. 235 - 240
• Main Authors: Nell, Sjoerd, Wijngaarde, Camiel A., Pistorius, Lourens R., Slieker, Martijn, ter Heide, Henriette, Manten, G.T.R., Freund, Matthias W.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.05.2013; S. Karger AG
• Subjects: Abnormalities, Multiple - diagnostic imaging; Abnormalities, Multiple - physiopathology; Abortion, Eugenic; Adult; Biological and medical sciences; Birth control; Cardiology. Vascular system; Cohort Studies; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Decision Making; Diseases of mother, fetus and pregnancy; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - physiopathology; Gynecology. Andrology. Obstetrics; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Hospitals, Special; Humans; Induced abortion. Therapeutic abortion; Male; Medical sciences; Netherlands; Original Paper; Parents; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy. Fetus. Placenta; Referral and Consultation; Retrospective Studies; Severity of Illness Index; Ultrasonography, Prenatal; Prenatal diagnosis; Ultrasound screening; Extracardiac malformations; Counseling; Congenital heart disease; Termination of pregnancy; Continuation of pregnancy; Pregnancy disorders; Parent; Cardiovascular disease; Council; Fetal diseases; Female; Anomaly; Woman; Sonography; Human; Decision making; Induced abortion; Medical screening; Decision; Pregnancy; Malformation; Echography; Congenital cardiopathy
• ISSN: 1015-3837; 1421-9964
• DOI: 10.1159/000346564

Objective: This study describes the association between the complexity of congenital cardiac and extracardiac malformations, and the parental decision of pregnancy continuation or termination. Methods: Congenital heart defects (CHD) was diagnosed by ultrasound in 251 fetuses before the 24th week (23 + 6 weeks) of gestation during the four year period from 2007 to 2010. All fetuses from the Utrecht region were referred to our center due to a strict referral pattern. The complexity and severity of the cardiac and possible extracardiac malformations were retrospectively categorized by a pediatric cardiologist and a perinatologist who were blinded to the pregnancy outcome. The groups with and without termination of pregnancy were compared using a univariate analysis and multivariate logistic regression. Results: In 119 (47%) of the 251 fetuses, parents opted for termination of pregnancy. In 103 of these cases (87%) there was a high complex or lethal cardiac, or a major or lethal extracardiac malformation. Of the 132 continued pregnancies, 42 fetuses (32%) had a high complex or lethal cardiac, or a major or lethal extracardiac malformation. There were significantly more terminations of pregnancy in case of a high or lethal complex cardiac or extracardiac anomaly (71 vs. 15%, p <0.001). Conclusion: Parents opted for termination of pregnancy significantly more often in cases with high complex cardiac and extracardiac malformations. It was rare for parents to opt for pregnancy termination in the absence of a severe cardiac or extracardiac malformation.