Correlation between fetal cardiac diagnosis by obstetric and pediatric cardiologist sonographers and comparison with postnatal findings

Abstract

Objective: To assess the level of agreement between obstetric and pediatric cardiologist sonographers' diagnosis of fetuses with suspected congenital heart disease and to compare this with the final postnatal diagnosis.

Design: We retrospectively reviewed the notes of 1037 patients undergoing fetal echocardiography over a 5-year period (1995-99) at the principal tertiary referral center for fetal cardiology in New South Wales, Australia. The median gestational age at presentation was 21 weeks (range 17-38) with 49% of the scans performed at < 21 weeks and a further 17% performed at 21-24 weeks. The accuracy of the fetal cardiac diagnosis was validated by neonatal cardiac investigation or autopsy.

Results: A total of 249 cases of congenital heart disease were identified antenatally during this 5-year period with the majority (84%) referred because of suspicion of a cardiac malformation during an obstetric scan. Of the 268 fetuses with congenital heart disease suspected by obstetric sonographers, 209 had confirmed cardiac defects. Complete correlation between obstetric sonographers' and pediatric cardiologists' prenatal cardiac findings was achieved in 62% of cases. There were major differences involving the atrioventricular morphology in 18% of cases and the outflow tract anatomy in 20%. Complete agreement between prenatal and postnatal diagnosis in fetuses with complex congenital heart disease was achieved in 59% of cases for obstetric sonography (17% false positive; 41% false negative) and 95% for fetal echocardiography by pediatric cardiologists (2% false positive; 5% false negative).

Conclusions: Improved accuracy in diagnosis can be achieved through a pediatric cardiologist with special skills in fetal echocardiography working collaboratively with obstetric sonographers to optimize the details of diagnosis. This may influence management and counseling.