Iwona Strzelecka, Maciej Słodki, Andrzej Zieliński, Iwona Maroszyńska and Maria Respondek-Liberska
Prenatal diagnosis is an integral part of modern perinatal care. In the article results of questionnaires pertaining to the prenatal process of diagnosis are presented. Parents whose children were afflicted with congenital malformations of all types responded to enquiry
Materials and methods:
Between March 2014 and March 2015 150 of 355 infants were hospitalized in the Department of Pediatric Intensive Care and Congenital Malformations in Łódź, and 150 had congenital malformations.
101 parents of 150 children (67,3%) have given the feedback. Anomalies were such as: of the digestive system (37%), CHD (25%), OUN (14 %), genito-urinary (13%), skeletal system (9%) and respiratory system (2%). In 65 children of 101 the defects were detected prenatally. The obstetric US exam was the most frequently pointed out as performed (more than 1200). The biochemical markers and genetic tests in were performed in 34 pregnancies. The high percentage of ability to detect malformation was reported in the group of fetal echo examinations.
1. Prenatal ultrasound exams were the least effective method of making appropriate prenatal diagnosis of congenital malformation.
2. Fetal echocardiography had a high level of sensitivity and specificity in detecting congenital malformations.
3. Prenatal cardiologists proved to be the most effective in detecting congenital malformations 89,3 % of detected abnormalities.
4. Biochemical exams had a positive result in only one case of Down Syndrome.
Iwona Strzelecka, Jadwiga Moll, Katarzyna Kornacka, Andrzej Zieliński and Maria Respondek-Liberska
A retrospective analysis of medical records of selected 83 cases (pregnant women and fetuses of patients from the database of the Department of Diagnosis and Prevention of Congenital Malformations ICZMP in Lodz in the years 2007-2012) who had minimum 2 echocardiographic exams. In this group 220 echocardiography exams were performed: in 62 fetuses 2x and in 21 fetuses 3x or more. After exclusion of intrauterine demises and terminated pregnancies, 72 cases have been qualified for further analysis. Heart defects in this material were initially divided into four groups: the most serious defects, critical, serious and evolving. Group of the most serious defects was excluded from the 2nd stage of analysis. An attempt to subtract the group of “evolving” heart defects from the group of severe and critical defects was conducted. This group of defects was initially classified as “severe evolving to the critical”, as hemodynamics progression was observed during intrauterine life. Mortality in the subgroup of evolving defects was 71.4 %, in the group of critical defects 36.8 % and in the group of heavy defects 34.4 % ( chi-square test 0.05). In the group of evolving defects the mortality rate after cardiac surgery was :7/11 infants (63 %) and in the group of severe defects 7/26 (26.9 % ) (Fisher test 0.018). There were no other differentiating features found within the statistical analysis of the study groups.
Conclusions: Prenatal classification of fetal heart defects based on echocardiographic monitoring allows to observe the progression of hemodynamic changes in selected fetuses. This group of defects was encumbered with the greatest mortality in the neonatal and postoperative period.
Iwona Strzelecka, Eliza Michalska, Katarzyna Zych-Krekora and Maria Respondek-Liberska
Introduction: Echocardiography of the fetal heart is an ultrasound examination that allows the evaluation of the anatomical structure and cardiovascular system usually performed in first half of pregnancy. Material and methods: This work presents the data of 107 fetuses with normal heart anatomy (NHA) and normal heart study (NHS) and their neonatal follow-up. In this group (in an addition to routine prenatal work-up) has been performed also a echocardiography examination in the third trimester of pregnancy, after 37th week of gestation: 61% of pregnant women were referred to the prenatal cardiology center due to the presence of high-risk pregnancies and 39% were low-risk pregnancies. Results: In two cases episodes of fetal arrhythmias were present during obstetrical examinations. After birth in the study group of 107 fetuses, 72% of newborns left the hospital during the 4 days and 28% newborns stayed in the hospital for longer time. In 16 cases their stay was extended due to maternal reasons and in 14 for newborns reasons. Conclusions: 1) In the neonate group, after prenatal cardiac evaluation > the 37th week of gestation such as “ normal fetal heart anatomy & normal heart study”, all newborns in our center were born in good general condition. 2) Late prenatal echocardiography in 3rd trimester of pregnancy maybe considered as additional tool to prove fetal well being, specially in high risk pregnancies.
Iwona Strzelecka, Maria Respondek-Liberska, Maciej Słodki, Katarzyna Zych-Krekora and Bettina Cuneo
Based on fourteen case reports from various centres from 1992-2015 and three original studies in 2006-2011, 122 fetuses were subjected to analysis. In these reports, transplacental digoxin treatment was administered to different cardiac anomalies such as SVT , Ebstein’s anomaly, critical AS , absent pulmonary valve syndrome, complete heart block, in foetuses with aneurysm/diverticulum of LV, in tricuspid atresia or dysplasia, rhabdomyoma, pulmonary atresia, HLHS with fibroelastosis, in TTTS and in extracardiac anomalies such as atriovenous malformation or sacrococcygeal teratoma. There was no statistical difference to suggest (Chi-square test) that digoxin was more efficient to control fetal arrhythmias than fetal congestive heart failure in nonarrhythmic patients.
Conclusions: Foetal cardiac insufficiency may appear due to different reasons (in normal heart anatomy or in heart defects, in normal sinus rhythm or due to foetal arrhythmias: tachycardias or severe bradycardia) and may be a cause of intrauterine demise. So far, we do not have strong evidence that digoxin treatment may prevent foetal death or prematurity. More research is needed to ascertain if the prolonging of pregnancy resulted from digoxin treatment or if improvement in foetal circulatory insufficiency was influenced by spontaneous regression of foetal cardiac symptoms.
Iwona Strzelecka, Joanna Płużańska, Jerzy Węgrzynowski, Tomasz Moszura, Maciej Słodki and Maria Respondek-Liberska
Most heart defects form between 4 and 6 weeks after fertilization. The detection rate is still growing. Despite significant progress in prenatal diagnosis some cases still go undetected. We present two cases of similar defects: prenatally detected and undetected, both presenting with a normal four chamber view in mid-pregnancy. We compared the follow-up of both neonates along with sustained health and economic consequences. The dynamics of the development of heart defects during prenatal life suggests the legitimacy to perform additional, late echocardiography exams (35-38 weeks of gestation)
Iwona Strzelecka, Maciej Słodki, Katarzyna Zych-Krekora, Michał Krekora, Mariusz Grzesiak, Iwona Maroszyńska and Maria Respondek-Liberska
Introduction: Congenital heart defects are the most frequent reason for deaths during the neonatal and early infancy periods. The aim of this study was to retrospectively analyze singleton pregnancy outcomes of premature neonates with congenital cardiac defects delivered by Cesarean section. Materials and methods: A retrospective analysis was performed on 10,800 fetuses evaluated in our referral fetal cardiac center between 2010 and 2016. A group of 58 singleton pregnancies was selected with the following criteria: fetal heart defect, Cesarean section (C-section), and gestation of 37 weeks or less. Exclusion criteria included labor outside of our hospital and multiple pregnancy. Results: Isolated heart defects constituted 74,1% (43 cases) of the analysed data set. The majority of newborns were delivered at 36 weeks of gestation (43,1%), with an average of 33,6 weeks. In one case (1,7%), C-section took place at 22nd week. Birth weight of newborns < 2500g constituted 51,7% (30 cases). Neonatal deaths occurred in 60,3% (35 cases). Conclusions: Preterm neonates with congenital heart defect, delivered by C-section in our reference centre, during 2010 to 2016, had generally poor outcomes and high mortality rate. The average hospital stay of surviving neonates was approximately two months. An improvement of knowledge about prenatal cardiology is necessary in obstetrician management with fetuses with congenital heart diseases.
Maria Respondek-Liberska, Łukasz Sokołowski, Maciej Słodki, Katarzyna Zych-Krekora, Iwona Strzelecka, Michał Krekora, Iwona Maroszyńska, Jadwiga Moll and Jacek Moll
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography.