Funding outcome

Fetal echocardiography- the use of ultrasound or sound waves to image a baby's heart while in the mother's womb - is a critical tool in allowing the detection and diagnosis of structural congenital (before birth) heart defects (CHD) before birth. A diagnosis of CHD before birth has been shown to lead to improved care of the pregnant mother, with the baby being delivered in the best place for care and at the best time. However, there have been very few studies that have examined the accuracy of fetal echocardiography, which is key to ensuring the counseling is accurate and the care of the pregnancies and newborns is the best it could be. This project will examine the accuracy of fetal echo in defining the anatomy of CHD before birth with comparison to findings in the babies after birth by echo, at surgery and/or at autopsy. We will be reviewing 12 different CHD subtypes including over 500 cases diagnosed before birth within the University of Alberta's Fetal & Neonatal Cardiology Program between 2004 and 2017. Differences between diagnoses made before and after birth will be categorized based on the importance of the differences between the before and after birth findings: 1) no difference, 2) minor difference with no impact on clinical outcome 3) difference that has a minor impact on surgical care, 4) major differences which impacts the acute care and surgical outcomes of the baby and 5) differences in category that could impact counseling around associated conditions. We will also explore other factors that impact accuracy in defining anatomy including CHD subtypes and anatomical elements that are more difficult to evaluate before birth, the year of assessment, and serial assessments before birth. We hypothesize that the accuracy of fetal echocardiography is relatively high, has increased over the years , and that serial assessments improve diagnostic accuracy. Through potentially identifying modifiable factors to enhance our assessments, we hope to improve the care of affected babies.