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Prenatal screening for major congenital heart disease: assessing performance by combining national cardiac audit with maternity data
  1. Helena M Gardiner1,2,3,4,
  2. Alexander Kovacevic2,4,5,
  3. Laila B van der Heijden2,4,
  4. Patricia W Pfeiffer6,
  5. Rodney CG Franklin2,7,
  6. John L Gibbs8,
  7. Ian E Averiss9,
  8. Joan M LaRovere2,6,10
  1. 1HMG Reader in Perinatal Cardiology Imperial College London, Hon Consultant at Queen Charlotte's and Chelsea Hospital, London, UK
  2. 2Department of Paediatric Cardiology, Royal Brompton and Harefield Hospital, NHS Foundation Trust
  3. 3Obstetrics and Gynecology, Texas Fetal Center, University of Texas at Houston
  4. 4IRDB, Faculty of Medicine, Imperial College London
  5. 5Heinrich-Heine-University Dusseldorf, Germany
  6. 6Cardiovascular Clinical Outcomes Group at Boston Children's Hospital
  7. 7Current Clinical Lead NICOR-Congenital, UK
  8. 8Immediate Past Lead Clinician for Congenital Cardiac Audit, NICOR, UK
  9. 9Tickers charity ( and co-ordinator of the fetal heart training programme
  10. 10Division of Cardiovascular Critical Care, Boston Children's Hospital Division of Cardiovascular Critical Care
  1. Correspondence to Dr Helena M Gardiner, Texas Fetal Center, University of Texas at Houston, UT Professional Building, 6410 Fannin, Suite 210, Houston, Texas 77030, USA; helena.m.gardiner{at}


Objective Determine maternity hospital and lesion-specific prenatal detection rates of major congenital heart disease (mCHD) for hospitals referring prenatally and postnatally to one Congenital Cardiac Centre, and assess interhospital relative performance (relative risk, RR).

Methods We manually linked maternity data (3 hospitals prospectively and another 16 retrospectively) with admissions, fetal diagnostic and surgical cardiac data from one Congenital Cardiac Centre. This Centre submits verified information to National Institute for Cardiovascular Outcomes Research (NICOR-Congenital), which publishes aggregate antenatal diagnosis data from infant surgical procedures.

We included 120 198 unselected women screened prospectively over 11 years in 3 maternity hospitals (A, B, C). Hospital A: colocated with fetal medicine, proactive superintendent, on-site training, case-review and audit, hospital B: on-site training, proactive superintendent, monthly telemedicine clinics, and hospital C: sonographers supported by local obstetrician. We then studied 321 infants undergoing surgery for complete transposition (transposition of the great arteries (TGA), n=157) and isolated aortic coarctation (CoA, n=164) screened in hospitals A, B, C prospectively, and 16 hospitals retrospectively.

Results 385 mCHD recorded prospectively from 120 198 (3.2/1000) screened women in 3 hospitals. Interhospital relative performance (RR) in Hospital A:1.68 (1.4 to 2.0), B:0.70 (0.54 to 0.91), C:0.65 (0.5 to 0.8). Standardised prenatal detection rates (funnel plots) demonstrating inter-hospital variation across 19 hospitals for TGA (37%, 0.00 to 0.81) and CoA (34%, 0.00 to 1.06).

Conclusions Manually linking data sources produced hospital-specific and lesion-specific prenatal mCHD detection rates. More granular, rather than aggregate, data provides meaningful feedback to improve screening performance. Automatic maternal and infant record linkage on a national scale, requires verified, prospective maternity audit and integration of health information systems.

  • Congenital Heart Disease

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