Background information

Prenatal diagnosis of CoHD

  • The use of foetal echocardiography has contributed to a substantial decrease of stillbirth, first-day-mortality and first-week neonatal mortality.
  • There has been a general decrease in the absolute number of deaths due to congenital heart disease over recent years due to improvements in perinatal care and cardiac surgery. This may, in part, be attributable to a lower birth rate of some very complex cardiac diseases in which there is a major trend for termination of pregnancy.

Differences in quality

  • There are large differences in the detection rate between countries.
  • The highest detection rate was found in Western European countries.
  • The lowest detection rate was found in Eastern European countries and those without official screening policies.
  • The reliability of the test results strongly depends on the examiner’s skills.

Prenatal diagnosis of CoHD and termination of pregnancy

  • Despite its value to the preparation of postnatal medical care, prenatal diagnosis of congenital cardiac malformations also leads to a termination of the pregnancy in several cases.
  • Between 1995 and 2000, the prenatal detection of congenital heart defects led to abortion in 15% of all cases, 45% of which were terminated due to complex congenital heart defects (French study from 2005).
  • The figures of termination of pregnancy are higher in other reports, mainly with respect to complex congenital heart defects, and vary according to the local socio-religious feelings.
  • In most European countries, termination of pregnancy is only allowed up to a certain gestational age (usually around 22–24 weeks of gestation). This certainly adds to the emotional pressure the parents feel when facing the decision of how to handle the prenatal diagnosis of a congenital heart defect, as the mean gestational age at diagnosis is usually between 20 and 24 weeks. This leaves only a very short time for the parental decision.