The impact of early diagnosis of fetal single-ventricle cardiac defects on reproductive choices

BACKGROUND: Congenital heart defects are the most common fetal anomaly. Congenital heart defects with single-ventricle cardiac defects have high mortality rates, and in pregnancies diagnosed with this condi-tion, patients are often offered termination of pregnancy as an option.OBJECTIVE: This study aimed to investigate the relationship between gestational age at diagnosis and reproductive choices in fetuses diag-nosed with single-ventricle cardiac defects.STUDY DESIGN: This was a retrospective single-center cohort study in which 158 patients with a fetal diagnosis of single-ventricle cardiac defects were reviewed. Cases were categorized as isolated or complex. Complex cases included fetuses with single-ventricle cardiac defects in addition to other fetal extracardiac anomalies or chromosomal abnormalities.RESULTS: A total of 158 patients were diagnosed with single-ventricle cardiac defects during the study period. Of those patients, 37 (23.4%) underwent termination of pregnancy, 113 (71.5%) delivered, and 8 (5.1%) had an intrauterine fetal demise. Gestational age at diagnosis and race were significant predictors of the termination decision. The median gestational age at diagnosis was earlier in the termination of pregnancy group (20.4 vs 23.6 weeks; P<.001). Pregnancies complicated by single -ventricle cardiac defects diagnosed in early gestation (11 0/7 to 14 5/7 weeks of gestation) were more likely to be terminated than pregnancies complicated by single-ventricle cardiac defects diagnosed in middle gesta-tion (15 0/7 to 27 5/7 weeks of gestation) and late gestation (& GE;28 weeks of gestation) (54.2% vs 23.2% and 2.9%; P<.001). Earlier gestational age at diagnosis was correlated with earlier gestational age at termination (r=0.92; P<.001).CONCLUSION: Termination of pregnancy was more common when the single-ventricle cardiac defect was diagnosed earlier in pregnancy. This could be explained by the fact that early diagnoses allow parents to make deliberate and informed decisions. Key words: congenital heart defect, fetal echocardiography, prenatal counseling, prenatal diagnosis, single-ventricle cardiac defect, termination of pregnancy

Automated summary

This study investigated the relationship between gestational age at diagnosis and reproductive choices in fetuses with single-ventricle cardiac defects. The results indicated that termination of pregnancy was more common when the defect was diagnosed earlier in pregnancy, as early diagnosis enables parents to make deliberate and informed decisions.