AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 20 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 Figure 6: Graphical representation of survival excluding TOPs from antenatal diagnosis until death or one year of life. The results of our study have some similarities with previous studies. Table 4 outlines similarities with previous studies. Table 4: Comparison of Study Findings Annor et al (current study) Friedberg et al [13] Adebo et al [4] Yildirum et al [5] Rasiah et al [14] Setting Cape Town, South Africa California, USA Minnesota, USA Istanbul, Turkey Birmingham, UK Year studied 2010- 2016 2002- 2004 2006- 2011 2002- 2007 1997- 2004 Cohort Size 55 20 31 62 99 Loss to follow up/outcome unknown 2% 11% 35% 0% 4% Average Maternal age 32 33 - 29 30 Average gestational age at diagnosis 23 26 20 24 23 Agreed to prenatal genetic testing 60% - - 100%* 43% Aneuploidy (%) 46% 30% 50% 40% 47% Additional non- cardiac anomalies 55% 30% - 60% 26% Heterotaxy Syndrome 13% 30% 33% 19% Not described Termination of pregnancy 33% 20% 10% 58%* 35% Intrauterine death or miscarriage 20% 0%** - 6,9% 15% Neonatal Death 11% 20%** - 8% 16% Had surgery in infancy 22% 30% 75%*** 25% 32%^ *All cases had prenatal genetic screening and all fetuses with an abnormal karyotype were terminated in the Yildirum et al. study. This may reflect local policy/practice. **No cases of miscarriage are documented in the Friedberg et al. study, but multiple causes of ENND from prematurity were noted. Definitions of viability were not included in the study. *** Cases in the Adebo et al. study were identified in the Paediatric cardiology surgical database, and included retrospectively if they had an antenatal diagnosis. ^ It is not specified if all of these surgeries took place in infancy CONCLUSION In this cohort, the survival of fetuses diagnosed with antenatal AVSD was negatively impacted by the presence of associated structural and /or chromosomal abnormalities. These additional factors influenced patients’ decision to accept a TOP. Results from this study will facilitate the counselling of parents in our setting who receive an antenatal diagnosis of AVSD. Quoting only limited information relating to surgical repair outcomes potentially fails to communicate the additional risks of miscarriage, spontaneous fetal demise, neonatal demise and infant death unrelated to surgery. The limitations of this study are 1) this study is small and so lacks power to show significant differences, if present, 2) the study terminates at one year of life. Death in childhood is not appreciated in this study, 3) specific surgical techniques and their outcomes were not discussed in this study. Further studies are required to assess whether prenatal AVSD diagnosis improves neonatal and infant outcomes; this would involve comparing the outcomes in this group to the outcomes of postnatally diagnosed AVSDs. There is a need for more research in this area that contextualizes the African experience and outcomes in cases with an antenatal diagnosis of AVSD. In the pursuit of achieving improved maternal and child health care across Africa, antenatal ultrasound plays an important role in identifying abnormalities, allowing counselling, informed decisions regarding TOP where applicable, and identifying fetuses that may need to be referred to higher levels of care at birth. Generating data regarding the outcomes of these antenatal diagnoses is necessary to facilitate counselling of expectant parents, planning neonatal care as well as the appropriate allocation of resources. More research on this subject needs to be prioritised in the developing world.