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Impact of fetal diagnosis of congenital heart disease on parents  

Choi, Eun Young (Department of Pediatrics, College of Medicine, Seoul National University)
Lee, Chang Hoon (Department of Pediatrics, College of Medicine, Seoul National University)
Yoon, Myung Ja (Department of Pediatrics, College of Medicine, Seoul National University)
Han, Eun Sook (Department of Pediatrics, Bundang Seoul National University Hospital)
Hong, Joon Suk (Department of Obstetrics and Gynecology, Bundang Seoul National University Hospital)
Jung, Yun Sook (Department of Pediatrics, Bundang Seoul National University Hospital)
Choi, Jung Yun (Department of Pediatrics, Bundang Seoul National University Hospital)
Publication Information
Clinical and Experimental Pediatrics / v.49, no.10, 2006 , pp. 1073-1078 More about this Journal
Abstract
Purpose : This study was performed to assess how a fetal diagnosis of congenital heart disease affects parents, as regards pregnancy management and care of infants after birth. Methods : Database search to find out abnormal fetal echocardiography performed at Seoul National University Children's Hospital from July 1988 to June 2003 revealed 370 examinations. After excluding both arrhythmias without structural cardiac disease and multiple pregnancies, 299 pregnancies remained and this data formed the basis of this analysis. We retrospectively reviewed the medical records with special attention to pregnancy outcomes and also tried to find out factors influencing parental decisions on whether to continue or terminate pregnancy. Results : In this study, the mean gestation age at diagnosis was $28{\pm}6.0weeks$. The mean age of mothers was $30{\pm}3.9$ years old. Younger gestational ages at diagnosis(P=0.000), more severe grades of fetal heart disease(P=0.002) and younger mothers(P=0.014) correlated with terminations of pregnanies. But the grades of fetal status, the grades of associated anomaly, whether in-vitro-fertilization was carried out or not and numbers of previous children were not significant. Conclusion : This study found that the earlier gestational ages at diagnosis, younger maternal age and higher grades of fetal heart disease tended to lead parent to select abortions. Fetal echocardiographies were performed too late. Moreover Koreans have a biased view that malformation is a something incurable and a tragedy not only to oneself, but also to a family. So parents select terminations of pregnancy, even in curable cases. This is very unethical.
Keywords
Fetal echocardiography; Congenital heart disease; Ethical issues; Illegal abortion;
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1 Chung JH, Seo JW, Kim CJ, Kim CW, Chi JG. Congenital anomalies observed by autopsies at the Seoul national university children's hospital. Korean J Pathol 1997;31:93-9
2 Yoo YG, Park YW, Cho JS, Lee YH, Han SS, Yoon HJ. Congenital heart disease and extracardiac anomalies. Korean J Obstet Gynecol 1999;42:601-5
3 Cho JS, Yoo YG, Choi HM, Lee YH, Park YW. The usefulness of fetal echocardiography as a screening test. Korean J Obstet Gynecol 1998;41:1968-71.
4 Allan LD. Fetal diagnosis of fatal congenital heart disease. J Heart Lung Transplant 1993;Suppl:159-60
5 Squarcia U. Fetal diagnosis of congenital cardiac malformations-a challenge for physicians as well as parents. Cardiol Young 1996;6:256-7
6 Allan LD, Chita SK, Sharland GK, Fagg NLK, Anderson RH, Crawford DC. The accuracy of fetal echocardiography in the diagnosis of congenital heart disease. Int J Cardio 1989;25:279-88   DOI   ScienceOn
7 Shinebourne EA, Carvalho JS. Ethics of fetal echocardiography. Cardiol Young 1996;6:261-3
8 Allan LD. Evolution of echocardiographic findings in the fetus. Circulation 1997;96:391-2
9 Ryu HM. The role of genetic counseling in the management of prenatally detected congenital heart defects. Korean J Perinatol 2002;13:254-9
10 Davis GK, Farquhar CM, Allan LD, Crawford DC, Campman MG. Structural cardiac abnormalities in the fetus : reliability of prenatal diagnosis and outcome. Br J Obstet Gynaecol 1990;97:27-31   DOI   ScienceOn
11 Kang JM, Koh YS. Analysis of cases requested to the ethics committee of an university hospital for the discontinuation of therapy. Korean J Crit Care Med 2005;20:68-75
12 Kim HJ, Kim YK, Koh DK, Kim HJ, Choi BW, et al. A prospective epidemiological study on birth defects : a community based pilot study. J Korean Pediatr Soc 2000; 43:738-45
13 Marco P, Chiara C, Francesco S, Elena Z, Gabriele G, Salvatore G. Fetal echocardiography in detecting anomalous pulmonary venous connection : four false positive cases. Br Heart J 1995;73:355-8   DOI
14 Hornberger LK, Sahn DJ, Kleinman CS, Copel JA, Silverman NH. Antenatal diagnosis of coarctation of the aorta; a multicenter experience. J Am Coll Cardiol 1994;23:417-23   DOI   ScienceOn
15 Allan LD. Echocardiographic detection of congenital heart disease in the fetus : present and future. Br Heart J 1995; 74:103-6   DOI
16 Allan LD. Fetal diagnosis of congenital heart disease. Cardiol Young 1996;6:258.
17 Sander GGS. Fetal diagnosis of congenital heart disease. Cardiol Young 1996;6:259-60
18 Lee HJ. Recent advance in congenital heart disease. J Korean Pediatr Soc 2000;43:733-7
19 Park SS, Yoon MJ, Kim JS, Seo JW, Noh CI, Choi JY, et al. Congenital heart and associated extracardiac anomalies in autopsies. J Korean Pediatr Soc 1998;41:354-62
20 Kwon BK. Artificial abortion and euthanasia : how can we face these issues in Korea- J Korean Med Asso 2001; 44:1046-51   DOI
21 Kim JE, Han JY, Oh DC, Kim YJ, Chung YC, Jung SH, et al. The current changing trend for termination of pregnancy (1993-2000). Korean J Obstet Gynecol 2001;44:2025- 30
22 Blake DM, Copel JA, Kleinman CS. Hypoplastic left heart syndrome : prenatal diagnosis, clinical profile, and management. Am J Obstet Gynaecol 1991;165:529-34   DOI   ScienceOn
23 Friedman AH, Copel JA, Kleinman CS. Fetal echocardiography and fetal cardiology : indications, diagnosis and management. Semin Perinatol 1993;17:76-88
24 Yagel S, Weissman A, Rotstein Z, Manor M, Hegesh J, Anteby E, et al. Congenital heart defects : natural course and in utero development. Circulation 1997;96:550-5   DOI   ScienceOn
25 Jeon HS, Seo HG. Abortion in Korea since 1945. Korean J Med Hist 2003;12:129-43
26 Chang AC, Huhta JC, Yoon GY, Wood DC, Tulzer G, Cohen A, et al. Diagnosis, transport, and outcome in fetuses with left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 1991;102:841-8
27 Simpson JM, Sharland GK. Natural history and outcome of aortic stenosis diagnosed prenatally. Heart 1997;77:205-10   DOI
28 Allan LD, Crawford DC, Anderson RH, Tynan MJ. Echocardiographic and anatomic correlates in fetal congenital heart disease. Br Heart J 1984;52:542-8   DOI
29 Allan LD, Cook A, Sullivan I, Sharland GK. Hypoplastic left heart syndrome : effects of fetal echocardiography on birth prevalence. Lancet 1991;337:959-61   DOI   ScienceOn
30 Anderson RH. Termination of pregnancy. Cardiol Young 1996;6:255
31 Allan LD, Sharland GK, Milburn A, Lockhart SM, Groves AMM, Anderson RH, et al. Prospective diagnosis of 1006 consecutive cases of congenital heart disease in the fetus. J Am Coll Cardiol 1994;23:1452-8.   DOI   ScienceOn