Clinical Audit on Fetal Echocardiography: Clinical Indications and Outcome

Abstract

Background: Fetal echocardiography helps in early recognition, and hence, prompt treatment of congenital heart diseases. Inability to do so leads to increased morbidity and mortality among children. Standards for fetal echocardiography are provided by the British Congenital Cardiology Association (BCCA) and Fetal Anomaly Screening Program of the NHS. Limited compliance to these standards leads to issues around quality of care. Aim and objectives: To identify gaps in adherence to the standards and development of action plan to improve compliance to the standards. Methods: Retrospective analysis was done on patients who had fetal echocardiography from July to December 2017. Source of data included Catalogue of Somatic Mutations in Cancer (COSMIC), Clinical Research Information System (CRIS), and patient notes available at the hospital. Total number of cases who had fetal echocardiography during the six months were forty. Results: Majority of the patients belonged to the age range of 20-30 years. Ten of the cases who underwent echo were inappropriate referrals while others had different indications, most common being previously affected child followed by diabetes mellitus. According to standards, early echo should be done at 18 weeks. Number of patients who needed an early fetal echocardiography were 14, however, only six of them actually received it. Thus, the compliance to standard was 43%. The eight patients who did not get an early fetal echocardiography did not get it due to delayed booking for echocardiography by the midwife. Conclusion: There are gaps identified in current practices. Early antenatal bookings for all pregnancies to ensure timely identification and referral of high risk women is required.