Objectives
Antenatal detection of major congenital heart disease (CHD) in Northern Ireland from 2003-2006 was 27%. In 2007 we delivered a regional one-year fetal echocardiography training course (with particular emphasis on outflow tract views). We aimed to assess the effect of training on antenatal detection of major CHD.
Methods
Training was offered to all obstetric radiographers performing routine anomaly scanning. The programme involved attendance at: a one-day fetal echocardiography foundation course, 2 regional fetal cardiology clinics, 2 supervised anomaly scanning sessions in each local hospital and 1 refresher afternoon. Antenatal detection rates were monitored during the training period. Data were obtained from: the regional fetal and paediatric cardiology database and post-mortem records. Defects were classified into 2 groups: those detectible on the 4 chamber view and those requiring outflow tract views for detection.
Results
Antenatal detection of major CHD improved from 27% (72/262) to 43% (36/84) during the year of training (p = 0.008). There was significant improvement in the detection of outflow tract view defects (8%, 7/92 vs. 21%, 6/28, p = 0.04) and also 4 chamber view defects (38%, 65/170 to 54%, 30/56, p = 0.04).
Conclusions
Training to include more detailed fetal echocardiography as part of routine anomaly scanning has significantly improved regional detection of major CHD. The majority of major defects visible on the four chamber view are now diagnosed antenatally. Training has also resulted in significantly greater detection of outflow tract view defects. There is room for further improvement and ongoing training has been implemented.