Determining the factors causing delayed referral for fetal echocardiography at a tertiary care hospital

OBJECTIVE: To determine the factors causing delayed referral for fetal echocardiography at a tertiary care hospital. BACKGROUND: Timely referral for fetal echocardiogram is considered essential for identification of congenital heart diseases, interventions, and counseling of parents. The present study highlights the factors associated with delayed referral for fetal echocardiography. MATERIAL AND METHODS: This prospective study includes a total of 200 pregnant females who were referred for fetal echocardiography. The data collected included referral indications, gestational age, maternal age, educational status, referral personale, and final diagnosis on echocardiography. RESULTS: The mean gestational age of presentation was found to be 33 weeks [standard deviation (SD), 4.8 weeks]. Among 200 females, 24% were referred at second trimester, 69% presented at third trimester, and 6% of the females presented at term. No female presented before 18 weeks of gestation. Our results showed that most of the females (94%) were referred by their gynecologist. Eighty-nine percent of the females were booked since the first trimester. The most common indication for referral was unexplained death of children (60%). Of 200 pregnant women, 40% were found to be illiterate and 60% were educated. However, the mean gestational age of presentation of illiterate females was 32.9 weeks (SD, 4.2 weeks), and for educated women it was 33 weeks (SD, 5 weeks). Congenital heart disease was diagnosed in 12% of the cases. CONCLUSION: On the basis of the results, it could be concluded that delayed presentation for fetal echocardiography was not associated with the educational status of females. By contrast, referral personnel were found to be responsible for the delayed referral of females. Therefore, we strongly recommend that both pregnant women and gynecologists be educated about the importance of timely diagnosis for identification of congenital heart diseases.