PP-017 Impact of prenatal diagnosis of congenital heart disease on neonatal morbidity and mortality

Congenital heart disease (CHD) has already been known as an important cause of significant morbidity and mortality in neonatal period. It is the most common reason for acute cardiac failure. The development of antenatal ultrasound has progressively allowed the early detection of these malformations, estimated at 45% in Europe.
The objective of this study was to describe the different ultrasound appearances of CHD diagnosed in antenatal care, their prognosis and postnatal outcome.

It was a retrospective, descriptive study conducted at the maternity center of the Farhat Hached University Hospital in Sousse, over a 4-year period (January 2020 - December 2023), and included all pregnancies in which CHD was diagnosed by morphological ultrasound.

We collected 32 CHD diagnosed antenatally. The average maternal age was 31 years. Type 1 diabetes was present in 3 cases. The pregnancy was complicated by gestational diabetes in 2 cases. Fetal ultrasound was performed at a mean term of 26 WG. Cardiac malformations included univentricular heart (7 cases), tetralogy of Fallot (4 cases), aortic (5 cases) or pulmonary (1 case) valve stenosis, hypoplasia or coarctation of the aorta (3 cases), transposition of the great arteries (3 cases), atrioventricular canal defect (4 cases), abnormal pulmonary venous return (2 cases), ventricular septal defect (4 cases), pulmonary atresia, truncus arteriosus and severe Ebstein's disease in 2 cases respectively. An association of syndromic malformations was found in 8 cases, including trisomy 21 and Di-George syndrome. Therapeutic interruption of pregnancy was indicated in 17 cases. For the others, delivery was carried out in our maternity hospital, by vaginal delivery, at term, assisted by the neonatology team. The Apgar was correct at birth in all NB. Admissions to the department were systematically indicated, with immediate management. The first clinical presentation was dominated by neonatal respiratory distress and cyanosis. The antenatal diagnosis was concordant with postnatal heart disease in 90% of cases, either on cardiac ultrasound or fetopathological examination. The subsequent outcome was fatal in 5 cases.

Antenatal diagnosis of CHD improves management of neonatal cardiological emergencies. The morbidity and mortality associated with surgery depends essentially on the severity of the malformation. In fact, the improvement of prenatal diagnosis has not been associated with an increase in the number of medical interruptions of pregnancy, but rather with improved prognosis of certain anomalies, such as transposition of the great arteries. Early diagnosis and referral to pediatric cardiac center for proper management will improve the outcome.