AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 19 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 Twelve (46,2%) of those infants born alive had corrective cardiac surgery during the first year of life. Surgical procedures included AVSD repairs, pulmonary artery banding, patent ductus arteriosus stenting, atrial septations or septectomies and modified Blalock-Taussig shunts. The maximum number of surgeries per case was three. One infant underwent additional non- cardiac surgery: this was a laparotomy for gut malrotation. Three of the infants who underwent cardiac surgery demised in the neonatal period. In only one of these cases was the cause directly related to the surgery: cardiorespiratory failure developed due to left ventricle overload after atrial septation. Of the 12 who underwent cardiac surgery, eight were alive at one year, and one was lost to follow up. There were eight deaths in infancy. The causes of death were unknown in four cases, cardiac failure in two cases and respiratory failure secondary to pneumonia in one case. One case was referred to palliative care after the infant showed no improvement after repeat cardiac surgery and another demised on the way to the hospital. Diagnostic Accuracy Postnatal echocardiograms (ECHO) were performed on 22 of the 26 born alive (84,6%). Those neonates who did not have a formal postnatal ECHO all demised in the neonatal period. In those who had a postnatal ECHO, findings were consistent with an AVSD in 13 (59,09%). Antenatally, the type of AVSD was largely undetermined, while postnatally the Rastelli type was usually specified. Postnatal ECHO diagnoses that were inconsistent with the antenatal AVSD diagnosis are listed in Table 3. Table 3. Inconsistent Post-Natal ECHO results (9 of 22) 1 Tricuspid atresia + VSD 2 Normal heart 3 Hypoplastic left ventricle, VSD, double outlet right ventricle (DORV), large PDA 4 Mitral atresia, DORV, malposition of the great vessels 5 Common Atrium, normal valves 6 Small ASD, DORV, double inlet right ventricle, 2 valves to right ventricle 7 Common atrium, 2 AV valves, large PDA, left isomerism, dextrocardia 8 VSD, TGA, PA, PDA 9 DCMO, apical VSD DISCUSSION Fetal diagnosis of AVSD has a significant impact on fetal, neonatal and infant outcomes. In this study, the cohort with an antenatal diagnosis of fetal AVSD comprised 55 cases. The rate of termination of pregnancy was 32,7%. The rate of miscarriage or IUFD was 20%. Of the resultant 47,3% born alive, 4 had an ENND and 2 had a LNND. A further 8 died in infancy (14,6%). The numbers of babies of the total cohort who survived to one year of life was 11 (20%). This figure represents 29,7% of the pregnancies that did not undergo TOP and 42,3% of those born alive. One case was lost to follow up: the baby was born alive, had two surgeries in infancy, was admitted for a total of 144 days in infancy and after discharge defaulted follow up. Of the 11 who survived, survival was impacted by the presence of additional anomalies, as well as the karyotype of the fetus or neonate. Four (36%) had a normal karyotype and four (36%) had T21. The remaining three survivors did not have karyotypes performed as they did not have syndromic features on a postnatal clinical assessment. Seven (63,6%) of the survivors had an isolated AVSD. Of the surviving infants, only one had an associated cardiac abnormality (dextrocardia with a limited impact). Additional structural abnormalities amongst the survivors included skeletal dysplasia, atrial isomerism (in heterotaxy syndrome) and duodenal atresia. Five (45,5%) of the surviving babies were born to diabetic mothers. There was no statistical impact on survival by the age of the mother or the gestational age at diagnosis. Survival is graphically displayed in Figures 3-6 below: Figure 3: Graphical representation of survival from time of antenatal diagnosis until death or one year of life. Figure 4: Graphical representation of fetal survival from antenatal diagnosis to 1 year of life with an isolated AVSD (green line) vs an AVSD with one or more additional anomalies Figure 5: Graphical representation of fetal survival from antenatal diagnosis of AVSD to 1 year of life with an abnormal karyotype (green line) vs a normal karyotype.