Alsweiler, JaneGentles, Thomas LVetten, Zoë Vanora2024-05-012024-05-012023https://hdl.handle.net/2292/68176Introduction: Accurate prenatal predictors of early postnatal intervention in tetralogy of Fallot (ToF) remain uncertain. Further information will aid prenatal risk assessment and decision-making to ensure birth in an appropriate setting. This study aimed to identify prenatal cardiac and non-cardiac predictors associated with early intervention (≤30 days after birth) in ToF and to characterise patients with ToF transferred in-utero for delivery. Methods: This was a retrospective study of infants with prenatally diagnosed ToF born between 2010 and 2019. Part one of the study included infants with ToF from participating cardiosurgical centres in Aotearoa New Zealand and Australia who underwent cardiac surgery or catheter intervention in their first year. A comparison of fetal echocardiogram measurements obtained from 28-32 weeks’ gestation was made between infants undergoing early and later (>30 days after birth) intervention. Part two of the study included all fetuses with ToF in Aotearoa New Zealand surviving to 36 weeks’ gestation. The recommendation for in-utero transfer to the cardiosurgical centre for delivery was based on expert opinion. The distances travelled for delivery and the period of relocation were compared between those undergoing early and later intervention. Results: Part one: Of 253 infants, 33 (13%) underwent early intervention. Infants requiring early intervention had lower pulmonary valve (PV) Z-scores (-4.7±.2 vs. -2.6±1.6; p<0.0001) and were more likely to have abnormal ductus arteriosus (DA) flow (14/30 (47%) vs. 15/152 (10%), p=0.004). A PV Z-score ≤-3.5 and/or abnormal DA flow strongly predicted the timing of intervention (sensitivity 79%, specificity 70%, AUC 0.81). Part two: Prenatal transfer to the cardiosurgical centre was undertaken in 30/105 (29%). The median distance travelled for delivery was 431 (IQR 180-871) kilometres at a mean gestational age of 37.4 weeks (± 10 days). Prenatal transfer was associated with early intervention (14/30, 47% vs. 4/75, 5%; p<0.0001). Post-hoc analysis of the fetal echocardiogram findings described in part one identified a PV Z-score ≤-3.5 and/or abnormal DA flow more commonly in infants requiring early intervention (14/16, 88% vs. 25/75, 33%; p=0.0001). Conclusion: Early intervention in ToF can be predicted from fetal echocardiogram measurements, including a PV Z-score ≤-3.5 and/or abnormal DA flow at 28-32 weeks’ gestation. These findings have implications for prenatal counselling and planning of prenatal obstetric care, particularly delivery location and the need for in-utero transfer.Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmhttp://creativecommons.org/licenses/by-nc-sa/3.0/nz/Thesis2024-04-29Copyright: the authorhttp://purl.org/eprint/accessRights/OpenAccess