(P081) TAILORING FETAL ECHOCARDIOGRAPHY INDICATIONS TO THE LIMITED RESOURCES IN SASKATCHEWAN

Background: Congenital heart disease (CHD) is the leading cause of infant mortality due to birth defects. Prenatal diagnosis of CHD using fetal echocardiography has many benefits including assessment of the optimal site for delivery and reduced costs to the healthcare system regarding treatment and transportation. The indications for fetal echocardiography screening for congenital heart disease (CHD) in Saskatchewan, Canada, were previously based on the 2014 American Heart Association recommendations. Due to limited resources, these indications were changed in 2017, to introduce an intermediate level where fetal echocardiography was only indicated if initial screening by obstetric ultrasound was abnormal. The aim of this study was to assess the clinical impact of these changes on the prenatal diagnostic rates of CHD in Saskatchewan.

METHODS AND RESULTS: All women undergoing fetal echocardiography screening for CHD in Saskatchewan for 3-years before (1Jan2014-31Dec2016) and after (1Jan2017-31Dec2019) these changes were introduced, were identified from our fetal echocardiography database. Data was abstracted retrospectively including: fetal echocardiography date and location; maternal age, location of residence and obstetrical history; and fetal echocardiography indication, gestational age, and cardiac and extra-cardiac diagnoses.
Women undergoing fetal echocardiography screening before (N=566) compared with after (N=597) these changes were introduced were of similar age (30.3±7.5 vs. 30.2±6.5 years, p=0.858) and at similar gestation (28.2±8.6 vs. 28.2±7.4 weeks, p=0.988). Maternal and fetal factors also appeared similar, other than maternal diabetes as the indication for fetal echocardiography (14% vs. 10%). This is likely due to maternal pre-existing diabetes with good control (HbA1c < 7% at conception) being changed to an intermediate risk indication. The percentage of CHD detected at fetal echocardiography remained similar (42% vs. 46%) before and after changing the indications for fetal echocardiography in Saskatchewan.

Conclusion: Introduction of an intermediate level of indications for fetal ECHO does not appear to have significantly affected prenatal diagnosis rates of CHD in Saskatchewan. This has important resource implications for our limited provincial availability of fetal echocardiography. This data is being used to inform healthcare resource planning in the development of a provincial Fetal Echocardiography Program to ensure all women in Saskatchewan receive optimum care independent of geographical location or socioeconomic demographics.