Mode of delivery in pregnancies complicated by major fetal congenital heart disease: a retrospective cohort study

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Journal of Perinatology , (29 May 2014) | doi:10.1038/jp.2014.104

C A WalshA MacTiernanS FarrellC MulcahyC J McMahonO FranklinD ColemanR MahonyS HigginsS CarrollP McParland and F M McAuliffe

Objective—To determine the mode of delivery in pregnancies complicated by complex fetal congenital heart disease (CHD).

Study Design—Five-year retrospective cohort study at a tertiary fetal medicine center (2007 to 2011). Cases of complex fetal CHD (n=126) were compared with 45069 non-anomalous singleton infants greater than or equal to500g to determine rates of emergency intrapartum cesarean section (CS), preterm delivery and induction of labor.

Result—Intrapartum CS is significantly higher in fetal CHD than non-anomalous controls (21% vs 13.5%, odds ratio (OR) 1.7, 95%confidence interval (CI): 1.0 to 2.7; P=0.035), predominantly related to CS for non-reassuring fetal status (OR 2.2, 95% CI: 1.1 to 4.1; P=0.022). Although fetal CHD did not increase emergency CS rates in nulliparous women, CS was significantly increased in multiparous pregnancies (OR 2.4, 95% CI: 1.8 to 4.6; P=0.014). Rates of preterm delivery (OR 3.4, 95% CI: 2.0 to 5.4; P<0.0001) and induction of labor (OR 1.9, 95% CI: 1.3 to 2.9; P=0.001) were higher in the CHD cases.

Conclusion—Emergency CS is increased in fetal CHD, attributed to a higher rate of CS for non-reassuring fetal status and seen mostly in multiparous women.










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