Features of perinatal diagnosis and tactics for congenital heart defects (the experience of si «Institute of pediatrics, obstetrics and gynecology named of academician o.m. Lukyanova of the nams of Ukraine», 2015–2019)

Abstract

Currently, congenital heart defects (CHD) remain the most common in the structure of all developmental abnormalities and often cause mortality of fetuses and newborns in the first month of life. Due to the success of cardiac surgery, complex reconstructive surgery for CHD, which were previously considered inoperable, became possible. Under these conditions, the main task in organizing assistance to children with CHD complications is the modern diagnosis and timely assistance in a heart surgery clinic. Most CHD are diagnosed during screening examinations of pregnant women with fetal echocardiography. However, it should be noted that not all CHD can be detected in utero in the fetus, and in such cases, the provision of optimal cardiac surgery for newborns may not be timely.
Purpose — to justify the perinatal tactics for CHD of the newborn, before being transferred to the cardiac surgery center.
Patients and methods. All pregnant women underwent complete fetal echocardiography with the establishment of topical diagnosis, functional assessment of the heart ventricles, as well as assessment of hemodynamic disturbances in the fetoplacental system, and identification of concomitant pathology. The optimal time chosen for examination of the fetus was 20–22 and 30–32 weeks of pregnancy. During the period of 2015–2019 a total of 8457 pregnant women were examined according to the algorithm developed by us in the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician A.N. Lukyanova of the NAMS of Ukraine». In 144 of them, hemodynamically significant congenital heart defects were diagnosed prenatally. In order to correctly assess the condition of the child at birth, the prenatal history and data of the ultrasound examination of the fetus have been carefully studied. The children underwent complete clinical and instrumental examination. Prenatal and postnatal ultrasound was performed on AcusonX300 (Siemens, Germany) and MyLabTwice (Esaote, Italy) devices.
Results and conclusions. Considering the literature data and the analysis of our own studies, pre- and postnatal management tactics have been developed for the detection of CHD in the fetus and newborn to provide timely specialized care to this category of patients to reduce mortality prevention of complications, increasing the duration and quality of children life.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.