ONE-YEAR AUDIT OF A REFERRAL FETAL ECHOCARDIOGRAPHY SERVICE

Aim. To perform a one year audit of a referral fetal echocardiography service.Methods. In 1992, 132 fetuses were referred for two dimensiona l fetal echocardiography, 40% being less than 24 weeks gestation. Vali dation of the accuracy of the fetal diagnosis by postnatal clinical or appropriate cardiac investigation was undertaken. Results. Indication s for referral were a family history of congenital heart disease (n=36 ), maternal indications, (40) suspected congenital heart disease on ob stetric scan, (21) noncardiac fetal abnormality (19) and fetal arrhyth mia. (16) The fetal echocardiogram was normal in 112, abnormal in 18 a nd not technically possible in two. The negative prediction of congeni tal heart disease was 96% accurate with four cases of congenital heart disease not diagnosed in utero. The positive prediction of congenital heart disease was 93% accurate with one false positive of a ventricul ar septal defect. The overall incidence of congenital heart disease wa s 17%. Four of 14 fetuses with major congenital heart disease had a ch romosomal abnormality and five a coexistent noncardiac abnormality. Th e outcome of these 14 fetuses was poor, with three stillbirths, one te rmination of pregnancy, seven neonatal deaths and three only surviving beyond the neonatal period. Eleven of 21 cases referred with suspecte d congenital heart disease on obstetric scan were abnormal. Conclusion . Detailed fetal echocardiography can predict significant congenital h eart disease with a high degree of accuracy. Suspected cardiac abnorma lity on obstetric scans warrants referral for detailed fetal echocardi ography, as do those considered at increased risk of congenital heart disease.