Prenatal grading of fetal congenital heart disease and its influence on decision making during pregnancy and postnatal period: a prospective study.

BACKGROUND: Congenital heart defects(CHDs) are an important cause of neonatal mortality and morbidity. With advances in diagnosis and treatment, many defects are now amenable to correction. There is a need for individualized approach to prenatally detected lesions to predict the likely prognosis. Assigning them into risk category helps in prenatal counseling, decision making, referrals and formulation of management plan to improve the outcome. OBJECTIVE: To grade the fetal CHDs according to severity and study its usefulness in decision making. METHODS: A prospective study at a tertiary care institute between 2016 and 18, including pregnant women with antenatal diagnosis of fetal CHD. Detailed fetal echocardiography was followed by classification of lesions into four risk categories using modified grading system: (A) extremely high risk; (B) high risk (C) moderate risk (D) low risk. Appropriate counseling was provided to facilitate decision making and further management. The grading was reviewed and revised again postpartum/post-mortem for correlation. RESULTS: Of the total 137 cases, almost half (45.53%) were Category B, while Category D, C and A had 24.1%, 20.4% and 10.2% of cases respectively. The mean gestation age at diagnosis was 26.5 weeks. Termination of pregnancy was done in 21 cases, mostly in Category B (71.4%) and of the 116 continued pregnancies, there were 16 intrauterine deaths. Prenatal and postnatal findings were available in 109 cases and kappa analysis for agreement between antenatal and postnatal grading showed good agreement (0.82). CONCLUSION: Prenatal grading of congenital heart disease is a reliable, structured and simplified tool that can be used for providing counseling and facilitate decision making.

Prenatal diagnosis of fetal right and left congenital ventricular aneurysms.

AIM: To describe the ultrasonographic appearance of fetal ventricular aneurysm. METHODS: Ultrasound characteristics of two cases of prenatally diagnosed fetal ventricular aneurysm were reviewed. RESULTS: There was one case of left ventricular aneurysm diagnosed by prenatal ultrasound at 38 weeks of gestation. Another case of fetal right ventricular aneurysm was diagnosed prenatally at 36 weeks of gestation. Both the babies expired in the immediate post-natal period. CONCLUSION: Congenital ventricular aneurysm is a rare cardiac malformation characterized by protrusion or out pouching of a portion of the ventricular wall. It is important to differentiate an aneurysm from diverticulum, as the latter has favorable prognosis. The aneurysms are usually large and have broad-based communication with the ventricular cavity in contrast to diverticuli, which are small and connected by a narrow base.

A women's support group for Asian international students.

International students underuse counseling services, which are grounded in Western cultural values. The authors describe a support group for Asian international students that they launched at a large midwestern university to help students feel at ease with American university life, address homesickness, language problems, and academic and social stressors. Co-leaders created a safe and culturally sensitive atmosphere where the women could network, socialize, and address their issues. Group treatment offers many advantages over individual counseling and can enhance the health of international students.