Objective To evaluate the impact of fetal diagnosis of life-threatening congenital heart disease (CHD) on mode of delivery and early neonatal outcomes.
Study Design 1-year retrospective cohort study of life-threatening CHD cases at a regional fetal cardiology unit (born June 2013–June 2014). Delivery outcomes were compared with 7630 deliveries over the same period in the tertiary obstetric unit.
Results Forty-eight cases were diagnosed prenatally. There were ten terminations of pregnancy (21%) and three intrauterine deaths (6%). One of IUDs was unexpected following CVS biopsy. There were 35 livebirths; with 33 born at the intended location and 2 born elsewhere. Of the 33 babies, the mean gestation 37.6 weeks, mean birth-weight 3180g and male-to-female ratio 3:1.
In CHD group (N=33), only six (18%) had spontaneous onset of labour (3 were not documented). Four (12%) had elective C-section (CS). Twenty inductions of labour (IOL) were carried out. IOL was significantly commoner in the CHD group than controls (77% vs 31% p < 0.05). Out of nine non-elective C-sections, two were semi-elective due to failed inductions; six were emergencies with one case not clearly documented. Overall CS rate was not significantly higher in the CHD group than controls (39% vs 32% p = 0.46). 20% (4/20) of vaginal deliveries were instrumental.
At birth, 3 babies (9%) required some airway support (IPPV) with no significance difference in spontaneous delivery or CS groups (p = 0.8). The majority (26/33, 78.8%) were transferred to cardiac surgical unit within the first 72 h of life. Of these 26 babies, two (8%) required surgery and five (19%) required emergency balloon atrial septostomy within the first 72 h. Survival of the CHD cohort was 97% at 30-days and survival to discharge was 94%. There was no difference (p = 0.75) in survival-at-hospital-discharge comparing vaginal delivery (12/13) with CS (19/20).
Conclusion The rate of IOL in CHD is higher than those found in another study.1 Despite higher induction rate, the rate of CS was no different compared to controls. Mode of delivery does not seem to impact on early outcomes. In comparison to other studies,2,3 survival for this group of antenatally-diagnosed CHD patients appears acceptable.
Walsh CA, MacTiernan A, Farrell S, Mulcahy C, McMahon CJ, Franklin O, Coleman D, Mahony R, Higgins S, Carroll S, McParland P, McAuliffe FM. Mode of delivery in pregnancies complicated by major fetal congenital heart disease: a retrospective cohort study. J Perinatol. 2014 29. doi: 10.1038/jp.2014.104
Trento L, Pruetz JD, Ruey K, et al. Prenatal diagnosis of congenital heart disease: impact of mode of delivery on neonatal outcome. Prenatal Diagnosis 2012;32: 1250–1255
Levey A, Glickstein JS, Kleinman CS, et al. The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 2010;31:587–97
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