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Background: Variability in prenatal diagnosis for congenital heart defect (CHD) has been documented in other countries, but has not been examined in detail across China. This study was aimed to evaluate prenatal diagnosis rate (PDR) in stillbirths and livebirths with CHD in southern China.
Methods: This population-based study enrolled all fetuses and infants with CHD included in the Guangdong Registry of CHD (2004-2014). We analyzed PDR according to the type of defect and geographic region. Defects were classified in hierarchical fashion into 1) “primary targets” for screening, including the seven categories of CHD that usually present in newborns with hypoxemia; 2) “secondary targets” for screening, including another seven types of CHD that sometimes present with hypoxemia; 3) minor defects, including other specified defects.
Results: We identified 9877 babies from 39 sites in 20 cities across southern China. The PDR for total CHD, primary and secondary targets was 22%, 57% and 74%, respectively. The three lesions diagnosed most frequently were severe pulmonary stenosis, double outlet right ventricle and hypoplastic left heart syndrome. Total anomalous pulmonary venous connection presented with the least PDR among critical CHDs. The PDR in primary and secondary targets increased every year, specifically, from 25% (2004) to 70% (2014). There was significant geographic variation in PDR across the province (range 0% – 44%, P < 0.001). Factors associated with increased PDR included lesions co-existing with extra-cardiac or chromosomal defects, increased complexity, identifiable on 4-chamber view and maternal residence in developed regions. More than 80% stillbirths with primary and secondly targets were diagnosed prenatally.
Conclusions: There is significant variability in the rates of prenatal diagnosis for critical CHD in southern China related to defect type and region. The findings raise concern for improving fetal imaging and referral protocols, population access to care, and developing fetal intervention to prevent death in utero.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Heart Disease: New Diagnostic Approaches in Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1231-012
- 2017 American College of Cardiology Foundation