ETHICAL ASPECTS OF FETAL ECHOCARDIOGRAPHY

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ETHICAL ASPECTS OF FETAL ECHOCARDIOGRAPHY

• Ida Jovanovic, V. Parezanovic, A. Ljubic et al.
• University Childrens Hospital
• Belgrade, Yugoslavia

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National Center for Fetal Echocardiography

• Working protocol
• Decision-making guidelines
• Ethical committee
• gynaecologist/perinatologist
• paediatric cardiologist
• cardiac surgeon
• social worker

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The aim of the study

• Ethical principles of fetal echocardiography
  related
• to the problem of
• termination of pregnancy

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Results (1991-2001)

• 2480 fetuses (15-39 weeks, mean 25,6)
• 132 fetuses with heart diseases (5.4)
• CHD 101
• CHD severe arrhythmias 8
• Arrhythmias 23
• Sensitivity 89.0
• Specificity 99.8

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Protocol for fetal CHD
Look for extracardiac anomaly kariotype
Fetus with CHD
Parents counseling
Applications for TOP
Continuing of the pregnancy
Ethical committee
Termination of the pregnancy
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Crucial decision-making elements

• Severity of CHD
• Long-term prognosis
• Gestational age

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Group 1

• Surgical repair Complete correction
• Prognosis Excellent/good long-term or
  intermediate prognosis
• 1a 1b
• ASD, PDA Simple ToF, TGA
• mild / moderate PS Severe PS
• VSD Moderate AS - CoAo
• 1c
• AVSD
• complex ToF, complex TGA
• DORV

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Group 2

• Surgical repair Complete correction
  repeated interventions
• Prognosis Fair results
• Common truncus arteriosus
• ToF with pulmonary atresia
• Severe AS
• Complex DORV

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Group 3

• Surgical repair Palliative surgery
• Prognosis Limited outcome
• (20-30 yrs. life expectancy)
• Tricuspid atresia, Double inlet ventricle
• Mitral atresia, complex pulmonary atresia
• Critical AS
• Pulmonary atresia with IVS
• HLHS
• It is not death, but dying which is
  terrible
• Henry Fielding, Amelia, 1751.

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Outcomes of fetuses with heart diseases
17-32 weeks (mean 25,4)
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Outcomes of fetuses with Group 1 CHD
3 VSDs trisomy 18,13 1 CoAo trisomy 21 1 VSD
multiple anomalies
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Outcomes of fetuses with Group 2 CHD
Long-term follow-up 3 alive operated abroad 1
died after abroad surgery
Neonatal death 26.4
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Outcomes of fetuses with Group 3 CHD
Long-term follow-up 2 alive operated abroad
Neonatal death 26.8
In utero death 3.6
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Gross national product
USD

• GDP

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Quality of medical services
Moral and ethical standards
Income
Prognosis of fetal heart diseases
Religion
Low