J Med Assoc Thai 2020; 103 (4):315-21

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Perinatal and Neonatal Outcomes of the Prenatal Diagnosis of Congenital Heart Disease in Ramathibodi Hospital
Hansahiranwadee W , Bumrungphuet S Mail

Objective: The primary objective was to determine the incidence and the types of congenital heart disease (CHD), and its association with chromosomal and syndromic abnormalities diagnosed prenatally at Ramathibodi Hospital. The secondary objective was to determine the perinatal outcome and its associated factors.

Materials and Methods: Antenatal care information of pregnant women carrying CHD fetuses including maternal characteristics, ultrasound findings, diagnosis, genetic results, and pregnancy outcomes were recorded retrospectively. After delivery, the neonatal diagnosis was made by a neonatologist, pediatric cardiologist, and geneticist if suspected of genetic or syndromic abnormalities.

Results: Among neonates delivered at Ramathibodi Hospital between January 2013 and December 2017, CHD was diagnosed in 180 pregnancies with the incidence of CHD at 15.62 per 1,000 births. Common diagnoses included a ventricular septal defect, atrioventricular septal defect, and pulmonary stenosis. Genetics studies were performed in 61.18%. The most identified chromosomal abnormalities were trisomy 18 (47.73%), trisomy 21 (20.45%), and monosomy X (13.64%). Delivery outcomes were live birth (55.26%), termination of pregnancy (38.82%), and stillbirth (5.92%). Early neonatal mortality was 226.19 deaths per 1,000 live birth. Chromosomal abnormality in fetuses with CHD varied significantly and associated with the termination of pregnancy and stillbirth while the severity of defects and preterm births notably associated with early neonatal mortality.

Conclusion: CHD is one of the most common congenital defects that affects perinatal and neonatal outcomes, and prenatal diagnosis remains challenging. In case of suspected cardiac defect, accurate ultrasonographic diagnosis of cardiac and extracardiac malformations are fundamental steps in antenatal care. Chromosomal analysis is mandatory whereas genetic laboratory and personnel are available. Current individual data in terms of treatment and prognosis should be carefully discussed. Delivery and neonatal care plan by the multidisciplinary team can provide optimal delivery time and appropriate treatment for CHD neonates.

Keywords: Congenital heart defect, Chromosomal abnormality, Pregnancy outcomes, Neonatal mortality

Received 28 Mar 2019 | Revised 1 Jul 2019 | Accepted 5 Jul 2019

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