Prenatal diagnosis and planned peripartum care improve perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum in low‐resource settings

ABSTRACT Objective To report on the feasibility of establishing a regional prenatal referral network for critical congenital heart defects (CHDs) and its impact on perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum (TGA‐IVS) in low‐resource settings....

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Published in:	Ultrasound in obstetrics & gynecology Vol. 58; no. 3; pp. 398 - 404
Main Authors:	Kunde, F., Thomas, S., Sudhakar, A., Kunjikutty, R., Kumar, R. K., Vaidyanathan, B.
Format:	Journal Article
Language:	English
Published:	Chichester, UK John Wiley & Sons, Ltd 01-09-2021 Wiley Subscription Services, Inc
Subjects:	Adult Arteries Cardiology - methods Diagnosis Feasibility Studies Female Fetuses Gestation Gestational Age Gynecology Health Resources - supply & distribution Heart Humans India Infant mortality Infant, Newborn Live Birth low‐resource setting Medical diagnosis Mortality Neonates Obstetrics Patients Pediatrics Perinatal Care - methods Perinatal Mortality perinatal outcome Perinatology - methods Pregnancy Prenatal diagnosis Program Evaluation Referral and Consultation - statistics & numerical data Retrospective Studies Septum Surgery TGA Transposition Transposition of Great Vessels - diagnosis Transposition of Great Vessels - embryology Transposition of Great Vessels - mortality transposition of the great arteries Ultrasonic imaging Ventricle Ventricular Septum - embryology Ventricular Septum - pathology India transposition of the great arteries low-resource setting prenatal diagnosis perinatal outcome TGA
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Summary:	ABSTRACT Objective To report on the feasibility of establishing a regional prenatal referral network for critical congenital heart defects (CHDs) and its impact on perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum (TGA‐IVS) in low‐resource settings. Methods This was a retrospective study of consecutive fetuses with a diagnosis of TGA‐IVS between January 2011 and December 2019 in Kochi, Kerala, India. A regional network for prenatal diagnosis and referral of patients with critical CHDs was initiated in 2011. Pregnancy and early neonatal outcomes were reported. The impact of the timing of diagnosis (prenatal or after birth) on age at surgery, perinatal mortality and postoperative recovery was evaluated. Results A total of 82 fetuses with TGA‐IVS were included. Diagnosis typically occurred later on in gestation, at a median of 25 (interquartile range (IQR), 21–32) weeks. The majority (78.0%) of affected pregnancies resulted in live birth, most (84.4%) of which occurred in a specialist pediatric cardiac centers. Delivery in a specialist center, compared with delivery in a local maternity center, was associated with a significantly higher rate of surgical correction (98.1% vs 70.0%; P = 0.01) and overall lower neonatal mortality (3.7% vs 50%; P = 0.001). The proportion of cases undergoing arterial switch operation after prenatal diagnosis of TGA‐IVS increased significantly, along with the prenatal detection rate, over the study period (2011–2015, 11.1% vs 2016–2019, 29.4%; P = 0.001). Median age at surgery was significantly lower in the prenatally diagnosed group than that in the postnatally diagnosed group (4 days (IQR, 1–23 days) vs 10 days (IQR, 1–91 days); P < 0.001). There was no significant difference in postoperative mortality (2.0% vs 3.6%; P = 0.49) between the two groups. Conclusions This study demonstrates the feasibility of creating a network for prenatal diagnosis and referral of patients with critical CHDs, such as TGA, in low‐resource settings, that enables planned peripartum care in specialist pediatric cardiac centers and improved neonatal survival. © 2020 International Society of Ultrasound in Obstetrics and Gynecology
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0960-7692 1469-0705
DOI:	10.1002/uog.23146