Key result
Prenatal grading of fetal congenital heart disease into four risk categories showed good agreement with postnatal and post-mortem grading (kappa 0.82).
Why the study?
An individualized approach to risk-categorize prenatally detected congenital heart defects was needed to predict prognosis and aid in prenatal counseling, decision making, referrals, and management planning.
Does prenatal grading of fetal congenital heart disease facilitate decision making and correlate with postnatal findings in pregnant women with fetal CHD?
Observational (n=137)
No
Does prenatal grading of fetal congenital heart disease facilitate decision making and correlate with postnatal findings in pregnant women with fetal CHD?
Effect estimate: kappa 0.82
Prenatal grading of fetal congenital heart disease using a modified risk category system shows good agreement with postnatal findings and facilitates clinical decision making.
Prenatal CHD grading may guide counseling and referrals; leaves open whether it improves outcomes without prospective validation.
BACKGROUND: Congenital heart defects(CHDs) are an important cause of neonatal mortality and morbidity. With advances in diagnosis and treatment, many defects are now amenable to correction. There is a need for individualized approach to prenatally detected lesions to predict the likely prognosis. Assigning them into risk category helps in prenatal counseling, decision making, referrals and formulation of management plan to improve the outcome. OBJECTIVE: To grade the fetal CHDs according to severity and study its usefulness in decision making. METHODS: A prospective study at a tertiary care institute between 2016 and 18, including pregnant women with antenatal diagnosis of fetal CHD. Detailed fetal echocardiography was followed by classification of lesions into four risk categories using modified grading system: (A) extremely high risk; (B) high risk (C) moderate risk (D) low risk. Appropriate counseling was provided to facilitate decision making and further management. The grading was reviewed and revised again postpartum/post-mortem for correlation. RESULTS: Of the total 137 cases, almost half (45.53%) were Category B, while Category D, C and A had 24.1%, 20.4% and 10.2% of cases respectively. The mean gestation age at diagnosis was 26.5 weeks. Termination of pregnancy was done in 21 cases, mostly in Category B (71.4%) and of the 116 continued pregnancies, there were 16 intrauterine deaths. Prenatal and postnatal findings were available in 109 cases and kappa analysis for agreement between antenatal and postnatal grading showed good agreement (0.82). CONCLUSION: Prenatal grading of congenital heart disease is a reliable, structured and simplified tool that can be used for providing counseling and facilitate decision making.
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Gowda et al. (2020) conducted an observational in Fetal congenital heart disease (n=137). Prenatal grading of fetal congenital heart disease was evaluated on Agreement between antenatal and postnatal grading (kappa 0.82). Prenatal grading of fetal congenital heart disease into four risk categories showed good agreement with postnatal and post-mortem grading (kappa 0.82).
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