Bondarenko N. P., Mamedova N. M.

DYNAMICS OF PRENATAL DIAGNOSIS AND NOSOLOGICAL STRUCTURE OF ISOLATED CONGENITAL HEART DEFECTS OF THE FETUS UNDER MARTIAL LAW

---

Show/Download

About the author:

Bondarenko N. P., Mamedova N. M.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

Congenital heart defects (CHD) of the fetus remain one of the leading causes of perinatal and infant morbidity and mortality. Timely prenatal diagnosis of fetal CHD is essential for pregnancy management, planning of delivery, and organization of specialized care for the newborn. This issue has become particularly relevant under martial law, when limited access to medical care, forced migration, evacuation, and disruption of routine antenatal care may affect the timing of ultrasound screening and prenatal verification of fetal cardiac pathology. The aim of the study was to perform a comparative analysis of the prevalence and anatomical variants of isolated congenital heart defects of the fetus without associated genetic syndromes in pre-war and wartime periods and to assess gestational age at the time of primary prenatal verification of cardiac pathology. A clinical-statistical and epidemiological study of 200 pregnant women was conducted at the Municipal Non-Profit Enterprise “Perinatal Center of Kyiv”. The study included a retrospective pre-war period covering 2019–2021 (n=74) and a prospective wartime period covering 2022–2026 (n=126). The wartime period included 76 pregnant women with antenatally diagnosed isolated fetal CHD and 50 women in the control group with physiological pregnancy and an antenatally healthy fetus. The nosological structure of CHD, the degree of hemodynamic significance, and gestational age at the time of primary verification were analyzed. Prenatal diagnosis was performed using ultrasound examination and expert fetal echocardiography. During the wartime period, a redistribution of the nosological structure of isolated fetal CHD was observed, with a tendency toward an increased proportion of complex critical defects. The proportion of transposition of the great arteries was 21.1% during the wartime period compared with 8.1% in the pre-war period. The proportion of hypoplastic left heart syndrome and other critical duct-dependent defects was 22.4% and 9.5%, respectively. The most pronounced differences were observed in the timing of prenatal diagnosis. The mean gestational age at primary verification of fetal CHD increased from 20.4±1.2 weeks in the pre-war period to 26.3±2.4 weeks during martial law. The proportion of cases diagnosed after 28 weeks of gestation reached 38.2%. Among internally displaced women and women from frontline regions, the mean gestational age at verification was 29.6±2.1 weeks, while in 15.6% of cases severe fetal cardiac pathology was detected immediately before delivery. The findings indicate a substantial reduction in the timeliness of prenatal diagnosis of isolated fetal CHD under conditions of martial law, particularly among internally displaced women and women from frontline regions. These findings support the need to improve interdisciplinary cooperation, ensure access to antenatal screening, and optimize referral pathways for pregnant women with suspected critical fetal cardiac pathology.

Tags:

Bibliography:

1. Sun HY. Prenatal diagnosis of congenital heart defects: echocardiography. Translational Pediatrics. 2021;10(8):2210–2224. DOI: https://doi.org/10.21037/tp-20-164
2. Xin H, Wang L, Ding G, Ding G, Meng L, Wan H. Current status and prospects of prenatal ultrasound diagnosis of congenital heart disease in fetuses: a narrative review. Translational Pediatrics. 2026;15(3):84. DOI: https://doi.org/10.21037/tp-2025-aw-798
3. Carvalho JS, Axt-Fliedner R, Chaoui R, Copel JA, Cuneo BF, Goff D, et al. ISUOG Practice Guidelines (updated): fetal cardiac screening. Ultrasound in Obstetrics & Gynecology. 2023;61(6):788-803. DOI: https://doi.org/10.1002/uog.26224
4. Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, et al. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2023;36(7):679-723. DOI: https://doi.org/10.1016/j.echo.2023.04.014
5. Sethi N, Miller S, Hill KD. Prenatal Diagnosis, Management, and Treatment of Fetal Cardiac Disease. NeoReviews. 2023;24(5):e285-e299. DOI: https://doi.org/10.1542/neo.24-5-e285
6. Bottelli L, Franzè V, Tuo G, Buffelli F, Paladini D. Prenatal detection of congenital heart disease at 12–13 gestational weeks: detailed analysis of false-negative cases. Ultrasound in Obstetrics & Gynecology. 2023;61(5):577–586. DOI: https://doi.org/10.1002/uog.26094
7. Mogilevkina I, Khadzhynova N. War in Ukraine: Challenges for women’s and perinatal health. Sexual & Reproductive Healthcare. 2022;32:100735. DOI: https://doi.org/10.1016/j.srhc.2022.100735
8. Mogilevkina I, Dobryanskyy D, MacDonald R, Watson D, Southall D. A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine. Conflict and Health. 2025;19(1):6. DOI: https://doi.org/10.1186/s13031-025-00644-6
9. Węgrzynowska M, Sahraoui N, Nenko I, Szlendak B, Baranowska B. Ukrainian women’s maternity care strategies in Poland after the outbreak of the full-scale war: Understanding unequal access to quality care. Social Science & Medicine. 2024;362:117409. DOI: https://doi.org/10.1016/j.socscimed.2024.117409
10. Krupelnytska L, Vavilova A, Yatsenko N, Chrzan-Dętkoś M, Morozova-Larina O, Uka A, et al. War in Ukraine vs. Motherhood: Mental health self-perceptions of relocated pregnant women and new mothers. BMC Pregnancy and Childbirth. 2025;25(1):253. DOI: https://doi.org/10.1186/s12884-025-07346-0
11. De Robertis V, Stampalija T, Abuhamad AZ, Bosco M, Chaoui R, Formigoni C, et al. Indications for fetal echocardiography: consensus and controversies among evidence-based national and international guidelines. Ultrasound in Obstetrics & Gynecology. 2025;65(6):682-693. DOI: https://doi.org/10.1002/uog.29224

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 217-221 pages, index UDC 618.33-007:612-007.2-039-073.7](477)"364"

DOI:

10.29254/2077-4214-2026-3-182-217-221