OBJECTIVE:To examine the feasibility and performance of implementing a standardized fetal cardiac scan at the time of a routine first-trimester ultrasound scan. METHOD:A retrospective, single-center study in an unselected population between March 2021 and July 2022. A standardized cardiac scan protocol consisting of a four-chamber and 3-vessel trachea view with color Doppler was implemented as part of the routine first-trimester scan. Sonographers were asked to categorize the fetal heart anatomy. Data were stratified into two groups based on the possibility of evaluating the fetal heart. The influence of maternal and fetal characteristics and the detection of major congenital heart disease were investigated. RESULTS:A total of 5083 fetuses were included. The fetal heart evaluation was completed in 84.9%. The proportion of successful scans increased throughout the study period from 76% in the first month to 92% in the last month. High maternal body mass index and early gestational age at scan significantly decreased the feasibility. The first-trimester detection of major congenital heart defects was 7/16, of which four cases were identified by the cardiac scan protocol with no false-positive cases. CONCLUSION:First-trimester evaluation of the fetal heart by a standardized scan protocol is feasible to implement in daily practice. It can contribute to the earlier detection of congenital heart defects at a very low false positive rate.

BACKGROUND:In 2010, Denmark was the first country to implement a targeted routine antenatal anti-D prophylaxis (tRAADP) program, offering fetal RHD genotyping to all nonimmunized D negative pregnant women. The program represented a shift from only postnatal prophylaxis to a combined antenatal and postnatal prophylaxis. This study aimed to evaluate the clinical effect of tRAADP in Denmark. STUDY DESIGN AND METHODS:This nationwide registry-based cohort study included all D negative women who gave birth between 2004-2020, identified through the National Medical Birth Register and the Departments of Clinical Immunology in Denmark. The clinical effect of tRAADP was assessed by comparing the incidence of new D immunization between 2004-2009 (non-tRAADP-cohort) and 2011-2018 (tRAADP-cohort). RESULTS:A total of 282 women were D immunized during pregnancy between 2004-2009 (non-tRAADP-cohort), and 167 between 2011-2018 (tRAADP-cohort). The incidence of new D immunization decreased from 0.46% (95% CI 0.41-0.52) in the non-tRAADP-cohort to 0.22% (95% CI 0.19-0.25) in the tRAADP-cohort. The risk reduction was statistically significant p < 0.001. Notably, in the tRAADP cohort 0.1% (95% CI 0.08-0.12) of new D immunizations occurred before the time of antenatal prophylaxis. DISCUSSION:tRAADP significantly reduced the incidence of new D immunization by more than half, thus demonstrating the expected effect. However, even with full adherence to the current program, some women with early fetomaternal hemorrhage (FMH) were still at risk. Future studies may evaluate the impact of administering an additional tRAADP dose earlier in the second trimester to prevent this.

INTRODUCTION:This report presents a rare case of spontaneous twin anemia-polycythemia sequence (TAPS) between two dichorionic fetuses in a spontaneous, homozygotic, dichorionic, triamniotic, triplet pregnancy treated with multiple intrauterine blood transfusions (IUTs) and partial exchange transfusions (PETs).CASE PRESENTATION:The pregnancy was diagnosed with stage IV TAPS at gestational week 25+1. The patient was treated with laser surgery combined with multiple IUTs and PETs. The triplets were delivered at a planned caesarean section at gestational week 28+1 with postnatal hemoglobin values of 18.21, 26.43, and 11.92 g/dL in triplet 1, 2, and 3, respectively. At 4 years of age, triplet 1 is considered healthy, triplet 2 is diagnosed with mild mental retardation, and triplet 3 with profound mental retardation and dystonic cerebral palsy.DISCUSSION:This is an extremely rare case of TAPS between dichorionic fetuses in a triplet pregnancy, and routine surveillance with measurement of middle cerebral artery peak systolic velocity in dichorionic pregnancies may contribute to the detection of similar cases in the future. Furthermore, this case contributes with rare long-term follow-up data of children treated for high-stage TAPS with multiple IUTs and PETs.

Paracetamol (N-acetyl-p-aminophenol (APAP), also known as acetaminophen) is used to relieve mild to moderate pain and reduce fever. APAP is widely used during pregnancy as it is considered safe when used as directed by regulatory authorities. However, a significant amount of epidemiological and experimental research suggests that prenatal exposure potentially alters fetal development. In this paper, we summarize the potentially harmful adverse effects of APAP and the limitations of the current evidence. It highlights the urgent need for a clinical trial, and the aim of the presented qualitative pilot study on APAP use during pregnancy is the feasibility of a large-scale randomized controlled trial (RCT). In the qualitative study, we included 232 Danish women from three hospitals in the spring of 2021. After recognizing the pregnancy, 48% had taken any APAP, and 6% had taken it weekly or more than weekly. A total of 27% who had taken APAP in the first trimester of pregnancy (even rarely) would potentially participate in an RCT. In a potential clinical trial, the women would need to be included early in the 1st trimester as the suspected harmful effects of APAP lies within this early reproductive developmental window. A possible recruitment strategy was explored. These data suggest that the target population appears positive towards an RCT. As a negative attitude among users has been considered the major hindrance for such a study, we cannot see hindrances for performing an RCT.

INTRODUCTION:The false-positive rate in the prediction of fetal anemia is 10-15%. We investigated if a new, noninvasive MRI method used as a supplement to ultrasound could improve the prediction. METHODS:Fetuses suspected of anemia and controls were scanned in a 1.5-tesla MRI scanner 1-4 times during pregnancy. Cases were scanned before and after intrauterine blood transfusion with a T1-mapping MRI sequence in a cross-section of the umbilical vein. RESULTS:Inclusion of 8 cases and 11 controls resulted in 10 case scans (2 cases were included twice) and 33 control scans. In controls, the T1 relaxation time was 1,005-1,391 ms; in cases with severe anemia, 1,505-1,595 ms, moderate anemia 1,503-1,525 ms, and no/mild anemia 1,245-1,410 ms. After blood transfusions, values dropped to 1,123-1,288 ms. The mean value in moderate and severe anemic cases was 275 ms higher than in controls (95% CI 210-341 ms, p < 0.0001), and after blood transfusion it was comparable to controls (3 ms, 95% CI -62 to 68 ms, p = 0.934). A 1,450-ms cut-off would have identified all cases in need of blood transfusion with no false-positive cases. CONCLUSIONS:Our findings indicate a potential for this new MRI method to improve the prediction of fetal anemia as a supplement to ultrasound.

BACKGROUND: Intrauterine transfusion for severe alloimmunization in pregnancy performed < 20 weeks' gestation is associated with a higher fetal death rate. Intravenous immunoglobulins may prevent hemolysis and could therefore be a noninvasive alternative for early transfusions. OBJECTIVE: We evaluated whether maternal treatment with intravenous immunoglobulins defers the development of severe fetal anemia and its consequences in a retrospective cohort to which 12 fetal therapy centers contributed. STUDY DESIGN: We included consecutive pregnancies of alloimmunized women with a history of severe hemolytic disease and by propensity analysis compared index pregnancies treated with intravenous immunoglobulins (n = 24) with pregnancies managed without intravenous immunoglobulins (n = 28). RESULTS: In index pregnancies with intravenous immunoglobulin treatment, fetal anemia developed on average 15 days later compared to previous pregnancies (8% less often < 20 weeks' gestation). In pregnancies without intravenous immunoglobulin treatment anemia developed 9 days earlier compared to previous pregnancies (10% more< 20 weeks), an adjusted 4-day between-group difference in favor of the immunoglobulin group (95% confidence interval, e10 tothorn18; P =.564). In the subcohort in which immunoglobulin treatment was started < 13 weeks, anemia developed 25 days later and 31% less < 20 weeks' gestation (54% compared to 23%) than in the previous pregnancy. Fetal hydrops occurred in 4% of immunoglobulin-treated pregnancies and in 24% of those without intravenous immunoglobulin treatment (odds ratio, 0.03; 95% confidence interval, 0e0.5; P =.011). Exchange transfusions were given to 9% of neonates born from pregnancies with and in 37% without immunoglobulin treatment (odds ratio, 0.1; 95% confidence interval, 0e0.5; P =.009). CONCLUSION: Intravenous immunoglobulin treatment in mothers pregnant with a fetus at risk for hemolytic disease seems to have a potential clinically relevant, beneficial effect on the course and severity of the disease. Confirmation in a multicenter randomized trial is needed.

ABSTRACTObjectiveTo estimate the prevalence of specific neurodevelopmental disorders in children believed to have isolated mild ventriculomegaly (IMV) prenatally in the second trimester of pregnancy, in order to optimize the counseling process.MethodsThis was a nationwide registry‐based study including all singleton pregnancies that had first‐ and second‐trimester ultrasound scans in the period 1st January 2008 to 1st October 2014, identified in the Danish Fetal Medicine Database and local clinical databases in Denmark. All fetuses diagnosed prenatally with IMV (measurement of the atrium of the lateral ventricles, 10.0–15.0 mm) between 18 and 22 weeks' gestation were followed up in national patient registers until the age of 2–7 years. Information was obtained on the diagnoses of intellectual disability, cerebral palsy, autism spectrum disorder, epilepsy and impaired psychomotor development. Neurodevelopmental disorders were compared between those with postnatally confirmed IMV and a reference population of children in the same age range.ResultsOf a cohort of 292 046 fetuses, 133 were found to have apparent IMV on the second‐trimester scan for fetal malformations. In 11 cases, long‐term follow‐up was not possible owing to termination of pregnancy, spontaneous miscarriage, neonatal death or loss to follow‐up. Of the 122 liveborn children followed up until 2–7 years, 15 were identified as having an additional abnormality while 107 were confirmed postnatally to have IMV. Of these 107 children, the diagnosis of a neurodevelopmental disorder was registered in six (5.6%), corresponding to an odds ratio of 2.64 (95% CI, 1.16–6.02), as compared with the reference population. The diagnoses were autism spectrum disorder, epilepsy and impaired psychomotor development. None of these 107 children was diagnosed with intellectual disability or cerebral palsy.ConclusionsOur results show that a confirmed diagnosis of IMV was associated with an increased risk of a neurodevelopmental disorder, as compared with the reference population, but the absolute risk was low and there were no cases of intellectual disability or cerebral palsy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

HomeCirculationVol. 138, No. 13Longitudinal Brain and Body Growth in Fetuses With and Without Transposition of the Great Arteries Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLongitudinal Brain and Body Growth in Fetuses With and Without Transposition of the Great ArteriesQuantitative Volumetric Magnetic Resonance Imaging Study Ditte E.S. Jørgensen, MD, Ann Tabor, MD, DMedSci, Line Rode, MD, PhD, Liv Dyre, MD, Charlotte K. Ekelund, MD, PhD, Signe G. Hellmuth, MD, Christopher K. Macgowan, PhD, Lone N. Nørgaard, MD, Mike Seed, MBBS, Karin Sundberg, MD, DMedSci, Kirsten Søgaard, MD, Lisa N. Jensen, MD and Niels Vejlstrup, MD, PhD Ditte E.S. JørgensenDitte E.S. Jørgensen Ditte E.S. Jørgensen, MD, Center of Fetal Medicine, 4002, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Email E-mail Address: [email protected] Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. Department of Medicine and Health Sciences, University of Copenhagen, Denmark (D.E.S.J., A.T.). , Ann TaborAnn Tabor Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. Department of Medicine and Health Sciences, University of Copenhagen, Denmark (D.E.S.J., A.T.). , Line RodeLine Rode Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark (L.R.). , Liv DyreLiv Dyre Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Charlotte K. EkelundCharlotte K. Ekelund Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Signe G. HellmuthSigne G. Hellmuth Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Christopher K. MacgowanChristopher K. Macgowan Division of Translational Medicine (C.K.M.), Toronto, Ontario, Canada. Department of Medical Biophysics (C.K.M.), University of Toronto, Ontario, Canada. , Lone N. NørgaardLone N. Nørgaard Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Mike SeedMike Seed Hospital for Sick Children (M.S.), Toronto, Ontario, Canada. Department of Pediatrics and Department of Diagnostic Imaging, Division of Paediatric Cardiology (M.S.), University of Toronto, Ontario, Canada. , Karin SundbergKarin Sundberg Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Kirsten SøgaardKirsten Søgaard Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. , Lisa N. JensenLisa N. Jensen Department of Obstetrics, Center of Fetal Medicine (D.E.S.J., A.T., L.R., L.D., C.K.E., S.G.H., L.N.N., K. Sundberg, K. Søgaard, L.N.J.), Copenhagen University Hospital Rigshospitalet, Denmark. and Niels VejlstrupNiels Vejlstrup Department of Cardiology (N.V.), Copenhagen University Hospital Rigshospitalet, Denmark. Originally published24 Sep 2018https://doi.org/10.1161/CIRCULATIONAHA.118.034467Circulation. 2018;138:1368–1370Adverse neurodevelopment is consistently reported in patients with transposition of the great arteries (TGA).1 In fetuses with TGA, the brain receives mainly substrate-deficient blood returning from the venous system. Our aim was to investigate longitudinal brain and body volume development in fetuses with isolated TGA. We hypothesized that an asymmetrical fetal brain/body growth is initiated early in pregnancy because the circulation in fetuses with TGA is already disrupted in the first trimester.We prospectively included pregnant women with fetuses diagnosed with isolated TGA and controls with normal first- and second-trimester scans. No cases or controls smoked or had diabetes mellitus, hypertension, or previous birthweight <2500 g. We measured total brain volume, cerebellar volume, intracranial cavity volume, and total fetal volume by quantitative volumetric MRI every fourth week from approximately gestational week 24 until delivery. We used a 1.5 Tesla MRI scanner (Avanto) and a 14-second 3D-SSFP sequence with acquisition parameters: echo time 1.74 ms, repetition time 3.99 ms, field of view 40×325×208 mm, spatial resolution 1.6×2.0×3.2 mm3 (interpolated to 0.8×0.8×2.0 mm3), and acceleration factor 4. MRI volumes were achieved by manual segmentation in Mimics (Materialise). Volumes at the initial scan were analyzed by linear regression analysis adjusted for sex and gestational age. For repeated measures, comparisons were made by linear mixed models, including fixed effects of TGA, gestational age, and sex with random intercept and slope. Contrasts were set at each completed week from gestational weeks 23 to 38. Statistical analysis was performed using Stata. The study was approved by the institutional review committees, and all participants gave written informed consent.Five fetuses with TGA and 11 controls had on average 4.2 MRI scans each (range 3–5) from gestational weeks 22.7 to 38.9 resulting in 67 MRI scans. Groups were similar regarding maternal age, body mass index, and birth weight. Examples of MRI volumes and fetal growth charts are shown in the Figure. The brain/body ratio was significantly lower, and the cerebellar/total brain ratio was significantly higher in cases compared with controls at the initial scan (mean gestational week 24.4, range 22.7–25.9) with P=0.002 and P=0.02, respectively. These significant findings persisted from gestational weeks 23 to 38 (P value at each week <0.005). The brain/intracranial cavity ratio was significantly lower in scans after 30 weeks (P value at each week <0.05). Total brain volume was significantly lower after gestational week 26 (P value at each week <0.01), and intracranial cavity volume was lower between gestational weeks 26 and 33 (P values ≤0.05). We found no significant differences regarding cerebellar volume or total fetal volume at any time during pregnancy.Download figureDownload PowerPointFigure. Longitudinal brain and body volume growth. A, Manual segmentation of MRI scans in 3 planes (left) and representative examples of brain, cerebellar, intracranial cavity, and fetal volumes at 24, 28, 32, 36, and 38+ gestational weeks (right). B, Mean (upper) and individual (lower) volume ratios. C, Growth charts for cases and controls. Cases are dark grey. Shaded bounds represent confidence intervals of the regression lines.This study presents the first individual, longitudinal growth charts of brain and body volume development in fetuses with TGA compared with controls and provides the first evidence of reduced brain volume and asymmetrical brain/body, cerebellar/total brain, and brain/intracranial cavity ratios from early in pregnancy. Because body growth was similar between groups, the lower brain/body ratio must be caused by impaired brain volume development. We are not aware of comparable studies of prenatal cerebellar growth in congenital heart disease. However, we speculate that if the higher cerebellar/total brain ratio can be explained by a relatively lower cortical to subcortical volume in cerebellum compared with the supratentorial brain, it indicates a prenatal prioritized growth of basic brain substructures in fetuses with TGA. This speculation is supported by a study of fetuses with hypoplastic left heart syndrome, which found highly significantly impaired white and cortical grey matter volumes but a less pronounced impairment in subcortical volumes.2 The lower brain/intracranial cavity ratio suggests larger cerebrospinal fluid spaces in fetuses with TGA, which corroborates similar evidence reported in fetuses with mixed congenital heart disease diagnoses.3 One of the mechanisms for impaired brain development may be decreased delivery of metabolic substrates to the brain because the aorta in a fetus with TGA receives blood returning from the venous system. This speculation is supported by studies showing significantly lower oxygen saturation in the ascending aorta, lower cerebral oxygen consumption, and a slower rise in the brain N-acetyl aspartate/choline-ratio in fetuses with TGA compared with controls.3,4The current recommendations for prenatal counseling and postnatal neurodevelopmental follow-up are divergent: The American Heart Association and American Academy of Pediatrics place these patients in a high-risk group for neurodevelopmental impairment1 while the International Society of Ultrasound in Obstetrics and Gynecology awaits further well-designed, long-term follow-up studies before recommending to counsel expectant parents about an increased risk of neurodevelopmental impairment.5 Although the sample is small, our findings strongly suggest that fetuses with TGA are at high risk of neurodevelopmental impairment, thus emphasizing the need for similar longitudinal studies extending into adulthood to elucidate the lifelong clinical impact of their unique pathophysiological circulation. Such studies are essential to nuance our pre- and postnatal counseling.Sources of FundingThis research was funded by the University of Copenhagen and the Danish Children's Heart Foundation.DisclosuresNone.FootnotesData sharing: The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.https://www.ahajournals.org/journal/circDitte E.S. Jørgensen, MD, Center of Fetal Medicine, 4002, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Email ditte.emilie.staub.[email protected]dkReferences1. Marino BS, Lipkin PH, Newburger JW, Peacock G, Gerdes M, Gaynor JW, Mussatto KA, Uzark K, Goldberg CS, Johnson WH, Li J, Smith SE, Bellinger DC, Mahle WT; American Heart Association Congenital Heart Defects Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association.Circulation. 2012; 126:1143–1172. doi: 10.1161/CIR.0b013e318265ee8aLinkGoogle Scholar2. Clouchoux C, du Plessis AJ, Bouyssi-Kobar M, Tworetzky W, McElhinney DB, Brown DW, Gholipour A, Kudelski D, Warfield SK, McCarter RJ, Robertson RL, Evans AC, Newburger JW, Limperopoulos C. Delayed cortical development in fetuses with complex congenital heart disease.Cereb Cortex. 2013; 23:2932–2943. doi: 10.1093/cercor/bhs281CrossrefMedlineGoogle Scholar3. Limperopoulos C, Tworetzky W, McElhinney DB, Newburger JW, Brown DW, Robertson RL., Guizard N, McGrath E, Geva J, Annese D, Dunbar-Masterson C, Trainor B, Laussen PC, du Plessis AJ. Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy.Circulation. 2010; 121:26–33. doi: 10.1161/CIRCULATIONAHA.109.865568LinkGoogle Scholar4. Sun L, Macgowan CK, Sled JG, Yoo SJ, Manlhiot C, Porayette P, Grosse-Wortmann L, Jaeggi E, McCrindle BW, Kingdom J, Hickey E, Miller S, Seed M. Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease.Circulation. 2015; 131:1313–1323. doi: 10.1161/CIRCULATIONAHA.114.013051LinkGoogle Scholar5. Paladini D, Alfirevic Z, Carvalho JS, Khalil A, Malinger G, Martinez JM, Rychik J, Ville Y, Gardiner H; ISUOG Clinical Standards Committee.ISUOG consensus statement on current understanding of the association of neurodevelopmental delay and congenital heart disease: impact on prenatal counseling.Ultrasound Obstet Gynecol. 2017; 49:287–288. doi: 10.1002/uog.17324CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Leon R, Mir I, Herrera C, Sharma K, Spong C, Twickler D and Chalak L (2021) Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes, Pediatric Research, 10.1038/s41390-021-01521-7, 91:4, (787-794), Online publication date: 1-Mar-2022. Verrall C, Yang J, Chen J, Schembri A, d'Udekem Y, Zannino D, Kasparian N, du Plessis K, Grieve S, Welton T, Barton B, Gentles T, Celermajer D, Attard C, Rice K, Ayer J, Mandelstam S, Winlaw D, Mackay M and Cordina R (2020) Neurocognitive Dysfunction and Smaller Brain Volumes in Adolescents and Adults With a Fontan Circulation, Circulation, 143:9, (878-891), Online publication date: 2-Mar-2021. Ho D, Josowitz R, Katcoff H, Griffis H, Tian Z, Gaynor J and Rychik J (2020) Mid‐gestational fetal placental blood flow is diminished in the fetus with congenital heart disease , Prenatal Diagnosis, 10.1002/pd.5791, 40:11, (1432-1438), Online publication date: 1-Oct-2020. Ortinau C and Shimony J (2020) The Congenital Heart Disease Brain: Prenatal Considerations for Perioperative Neurocritical Care, Pediatric Neurology, 10.1016/j.pediatrneurol.2020.01.002, 108, (23-30), Online publication date: 1-Jul-2020. White B, Rogers L and Kirschen M (2019) Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease, Current Opinion in Pediatrics, 10.1097/MOP.0000000000000829, 31:6, (783-788), Online publication date: 1-Dec-2019. Seed M (2019) Fetal Cerebral Consequences of Structural Heart Disease: Can These Be Ameliorated? Fetal Therapy, 10.1017/9781108564434.017, (157-165) Roy C, van Amerom J, Marini D, Seed M and Macgowan C (2019) Fetal Cardiac MRI, Topics in Magnetic Resonance Imaging, 10.1097/RMR.0000000000000218, 28:5, (235-244), Online publication date: 1-Oct-2019. Wang Z, Song H, Wang F, Zhao C, Huang R, Xue S, Li R, Qiu X, Xu Y, Liu X and Yang Y (2019) A New ISL1 Loss-of-Function Mutation Predisposes to Congenital Double Outlet Right Ventricle, International Heart Journal, 10.1536/ihj.18-685, 60:5, (1113-1122), Online publication date: 27-Sep-2019. September 25, 2018Vol 138, Issue 13 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.034467PMID: 30354424 Originally publishedSeptember 24, 2018 Keywordscongenital heart diseasemagnetic resonance imagingtransposition of great vesselsfetal developmentbrainPDF download Advertisement SubjectsCongenital Heart Disease

ObjectivesThe prenatal detection rate of congenital heart disease (CHD) is low compared with other fetal malformations. Our aim was to evaluate the prenatal detection of CHD in Eastern Denmark.MethodsFetuses and infants diagnosed with CHD in the period 01.01.2008-31.12.2010 were assessed regarding prenatal detection rate and accuracy, as well as correlation with nuchal translucency (NT) thickness.ResultsOut of 86121 infants, 831 were born with CHD (0.96%). The prenatal detection rate of all CHD' was 21.3%, of Major CHD' 47.4%. Full agreement between prenatal and postnatal/autopsy findings was found in 96% of prenatally detected diagnoses. An NT thickness >95(th) percentile was found in 15.0% fetuses with Major CHD'. Of Major CHDs' detected prenatally, 77% were picked up at the time of the malformation scan at weeks 18-21.ConclusionsNearly half of Major CHDs' were detected prenatally. The prenatal cardiac diagnoses showed a high degree of accuracy. Increased NT thickness as a screening tool for CHD performed moderately but is an important high risk group for specialist examination. A minority of the prenatally detected CHDs was identified because of extra scans performed in high risk pregnancies. (c) 2014 John Wiley & Sons, Ltd.