AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 17 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | Antenatally diagnosed atrioventricular septal defects: a descriptive cohort study of outcomes and associated factors related to survival The majority of the cohort was described as having a “complete” AVSD (n=50, 90,9%). Descriptors of the AVSD: • Off-setting of the valves was only commented on in 11 (20%). When mentioned, an abnormal off-setting of the valves was described in 10 out of 11 cases (91%) • Ventricular hypoplasia, or the presence of balanced or unbalanced ventricles was commented on 52,7% of the time. In those commented on, 68,9% had unbalanced ventricles i.e. the presence of ventricular hypoplasia. Associated structural anomalies: An isolated AVSD was identified in 18 (32,7%) cases. Thus 37 (67.2%) of the cohort had at least one other associated fetal abnormality. The average maternal age of those with an additional fetal abnormality compared to those without was 34,6 ± 6,05 years vs 30,2 ± 7,8 years. Table 1 and Figure 2 show the frequency of associated abnormalities in different organ systems. Most of these cases had more than one associated abnormality. Table 1. Associated Anomaly Frequency Frequency Percentage None (Isolated AVSD) 18 32,73% Additional cardiac (± in addition to other anomalies) 19 34,55% Additional non-cardiac abnormality (total group) 30 54,55% Musculoskeletal 15 27,27% Central nervous system 11 20,00% Gastrointestinal tract 8 14,55% Heterotaxy Syndrome 7 12,73% Genitourinary 5 9,09% Pulmonary 2 3,64% *Some cases had more than one additional anomaly, this table is not summative • An associated cardiac abnormality was the most common additional abnormality documented. Associated cardiac abnormalities included an overriding aorta, aortic stenosis, interrupted aortic arch, pulmonary valve atresia, double outlet right ventricle, transposition of the great vessels, common atrium, endocardial fibro-elastosis and an echogenic tumour of the left ventricle. • Musculoskeletal (MSK) anomalies included bilateral cleft lip and palate, skeletal dysplasia, short ribs, sacral agenesis (part of Ivemark Syndrome), micrognathia, abnormal hands, cystic hygroma, midline facial cleft and talipes equinovarus. • Associated central nervous system (CNS) anomalies included vermian hypoplasia or Dandy-Walker syndrome, ventriculomegaly, dilated cisterna magna, small cerebellum, alobar holoprosencephaly, occipital encephalocele and agenesis of the corpus collosum. • Associated gastrointestinal system (GIT) abnormalities included duodenal atresia, oesophageal atresia, omphalocele and a cystic stomach mass. • The frequency of heterotaxy syndrome was 12,7%. This was identified in the following ways: polysplenia, asplenia, situs inversus abdominus and right or left atrial isomerism. • Associated genitourinary (GUT) anomalies included hydronephrosis, dilated pelviureteric junction and a solitary kidney. • Uncommonly, respiratory system anomalies were found in association with AVSDs in two cases. The anomaly noted in both cases was pulmonary hypoplasia. AVSDdiagnosis at GSHduring studied period: 58 Studied cohort: 55 Diagnosis changed antenatally: 3 Offered amniocentesis: 53 (96%) OfferedTOP: 39 (71%) DeclinedTOP: 18 TOPacceptedbut not performed: 1 TOPPerformed: 20 TOPfailure andpatient absconded: 2 TOPDeath: 1 8 (33%) Miscarriage or IUFD: 11 (20%) LiveBirth: 26 (47%) Declined amniocentesis: 20 Decision regarding amniocentesis uncertain: 5 AmniocentesisPerformed: 28 Neonatal Death: 6 (23%) Infant Death: 8 (31%) Alive at 1year: 11 (42%) Losttofollowup: 1 (4%) Figure 1.