Routine prenatal screening for congenital heart disease: what can be expected? A decision-analytic approach
January 1997
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OBJECTIVES: This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies. METHODS: A decision model was developed that included the prevalence and history of congenital heart disease, characteristics of ultrasound, risk of abortion, and attitude toward pregnancy termination. Probabilities were obtained with a literature survey; sensitivity analysis showed their influence on expected outcomes. RESULTS: Presently, screening programs may prevent the birth of approximately 1300 severely affected newborns per million second-trimester pregnancies. However, over 2000 terminations of pregnancy would be required, 750 of which would have ended in intrauterine death or spontaneous abortion. Further, 9900 false-positive screening results would occur, requiring referral. Only the sensitivity of routine screening and attitude toward termination of pregnancy appeared to influence the yield substantially. CONCLUSIONS: The impact of routine screening for congenital heart disease appeared relatively small. Further data may be required to fully assess the utility of prenatal screening.
- Female
- Humans
- Sensitivity and Specificity
- Multivariate Analysis
- Predictive Value of Tests
- Pregnancy
- Pregnancy Outcome
- Attitude
- *Mass Screening
- *Prenatal Diagnosis
- Decision Support Techniques
- Diagnostic Tests, Routine
- Heart Defects, Congenital/*diagnosis/ultrasonography
- Ultrasonography, Prenatal
- Abortion, Spontaneous
- heart disease
- screening
- pregnancy
- heart
- anomaly
- disease
- ultrasound
- fetus
- sensitivity
- probability
- outcome
- model
- death
- echocardiography
- decision
- ultrasound examination
- result
- number
- termination
- parent
