Key result
Standardised prenatal consultation increased the live birth rate (50% vs 33%) and decreased the termination rate (50% vs 76%) for fetuses with d-TGA, though without statistical significance.
Why the study?
Does standardised prenatal consultation improve perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries?
Cohort (n=146)
No
Does standardised prenatal consultation improve perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries?
Standardised prenatal consultation may increase live birth rates and decrease termination rates for fetuses with d-transposition of the great arteries, though termination rates remain high.
Answers are grounded in this paper and cite their sources.
May support standardised prenatal consultation in d-TGA pregnancies; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: The aim of this study was to explore perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries and impacts of standardised prenatal consultation. METHODS: All fetuses with prenatally diagnosed d-transposition of the great arteries prospectively enrolled at South China cardiac centre from 2011 to 2015. Standardised prenatal consultation was introduced in 2013 and comprehensive measures were implemented, such as establishing fetal CHD Outpatient Consultation Service, performing standard prenatal consultation according to specifications, and establishing a multidisciplinary team with senior specialists performing in-person consultations. Continuous follow-up investigation was conducted. Perinatal and postnatal outcomes were compared before and after consultation including live birth, elective termination of pregnancy, spontaneous fetal death, stillbirths, referral for surgery, and survival. RESULTS: In all, 146 fetuses were enrolled with 41 (28%) lost to follow-up. Among 105 remaining fetuses, 29 (28%) were live births and 76 (72%) were terminated. After consultation, live birth rate was higher (50 versus 33%) and termination rate was lower (50 versus 76%), although there was no statistical significance. Excluding three live births without postnatal d-transposition of the great arteries, 65% (17/26) underwent arterial switch operation within 30 days. A total of three in-hospital deaths occurred and during the 10-month follow-up period, one death was observed. In one case, the switch procedure was performed at 13 months and the infant survived. Out of eight infants without arterial switch operation, two died. CONCLUSIONS: Live birth rate increased after consultation; however, termination remained high. Combining termination, patients without arterial switch operation, and operative mortality, outcomes of d-transposition of the great arteries infants can be improved. Standard consultation, multidisciplinary collaboration, and improved perinatal care are important to improve outcomes.
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Qu et al. (2017) conducted a cohort in prenatally diagnosed d-transposition of the great arteries (n=146). Standardised prenatal consultation vs. Before consultation (prior to 2013) was evaluated on Live birth (p=no statistical significance). Standardised prenatal consultation increased the live birth rate (50% vs 33%) and decreased the termination rate (50% vs 76%) for fetuses with d-TGA, though without statistical significance.
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