ANTENATAL DIAGNOSIS OF CONGENITAL HEART-DISEASE AND DOWNS-SYNDROME - THE POTENTIAL EFFECT ON THE PRACTICE OF PEDIATRIC CARDIOLOGY

Objective-To predict the effect of antenatal ultrasound screening for congenital heart disease and maternal serum screening for Down's syndr ome on the practice of paediatric cardiology and paediatric cardiac su rgery. Design-A retrospective and prospective ascertainment of all con genital heart disease diagnosed in infancy in 1985-1991. Setting-One E nglish health region. Patients-All congenital heart disease diagnosed in infancy by echocardiography, cardiac catheterisation, surgery, or n ecropsy was classified as ''complex'', ''significant'', or ''minor'' a nd as ''detectable'' or ''not detectable'' on a routine antenatal ultr asound scan. Results-1347 infants had congenital heart disease which w as ''complex'' in 13%, ''significant'' in 55%, and ''minor'' in 32%. 1 5% of cases were ''detectable'' on routine antenatal ultrasound. Assum ing 20% detection and termination of 67% of affected pregnancies, live born congenital heart disease would be reduced by 2%, infant mortality from congenital heart disease by 5%, and paediatric cardiac surgical activity by 3%. Maternal screening for Down's syndrome, assuming 75% u ptake, 60% detection, and termination of all affected pregnancies, wou ld reduce liveborn cases of Down's syndrome by 45%, liveborn cases of congenital heart disease by 3.5%, and cardiac surgery by 2.6%. Conclus ions-Screening for congenital heart disease using the four chamber vie w in routine obstetric examinations and maternal serum screening for D own's syndrome is likely to have only a small effect on the requiremen ts for paediatric cardiology services and paediatric cardiac surgery.