6539 Service evaluation of the fetal cardiology outreach clinic

Objectives Our Trust is a fetal medicine centre, serving a large region. Previously, many of our patients had to travel long distances to our linked specialist cardiac centre (SCC) to receive tertiary fetal cardiology assessment. To address this issue, we established a fortnightly fetal cardiology outreach clinic (FCOC). The project's aim is to assess how this clinic has facilitated the management of expectant mothers and newborns closer to their homes. Methods Women with estimated delivery dates between 21 January 2017 and 13 June 2020, who were referred for fetal cardiology review were included. Electronic patient records were reviewed, collecting data on the number of patients reviewed, the reasons for referrals, the proportion seen in the local FCOC and SCC, distances travelled by women to attend appointments, eventual cardiac diagnosis and pregnancy outcome. Results Over the 3.5-year period, 161 pregnancies involving 163 fetuses were referred for fetal cardiac review. A total of 301 fetal cardiology clinic visits occurred, with 226 in FCOC and 75 at SCC. Most referrals were related to possible/confirmed congenital cardiac disease (CHD), followed by family history (FH) of CHD, genetics, extracardiac issues, increased nuchal translucency (NT), poor views, and other factors (figure 1). Of the 163 fetuses, 12 pregnancies were interrupted (TOP) and 5 resulted in intrauterine death (IUD). The outcome for 24 babies born outside our Trust is unknown. There were 122 live births. Most babies had an eventual diagnosis of normal heart, followed by septal defects, aortic arch abnormalities, tetralogy of Fallot (TOF), hypoplastic left heart (HLH), coarctation (CoA)/hypoplastic arch, pulmonary valve abnormalities, pulmonary atresia with ventricular septal defect (PA-VSD) and other diagnoses (figure 2). Ninety-seven of the 122 live births were born at term, 18 required Prostin, 17 were transferred to SCC shortly after birth, and 16 underwent cardiac interventions within their first month of life. Notably, about 28,000 miles were saved by travelling to our FCOC rather than the SCC. All babies, except one recommended for delivery at the SCC, were born within our Trust or at a hospital in our region. Conclusion Our FCOC successfully saw almost 90% appointments, and almost all babies were born and cared for within our region, allowing families facing difficult news to be cared for and supported by the same paediatric team antenatally and postnatally. This initiative has also reduced time and stress associated with travelling and contributes to the NHS's sustainability goals.