Effects of prenatally diagnosed congenital heart disease on timing and mode of delivery

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.316-316
• Main Authors: Lowisz, Joanna, Gandhi, Rupali, Mansukhani, Sheena, Li, Yi
• Format: Article
• Language: English
• Subjects: Birth weight; Cardiovascular disease; Cardiovascular diseases; Congenital diseases; Coronary artery disease; Fetuses; Gestation; Gestational age; Health risk assessment; Heart diseases; Indication; Infants; Labor; Medical records; Mothers; Pediatrics; Prenatal diagnosis
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA4.316

Purpose: Prenatal diagnoses of congenital heart disease (CHD) may prompt non-spontaneous delivery (NSD). This may predispose infants and mothers to unnecessary risks associated with Caesarean section (CS) or planned induction of labor (IOL). However, there is no consensus on the appropriate mode of delivery for a fetus with known CHD. In addition, most fetuses with CHD are not at increased intrapartum risk or unable to tolerate spontaneous labor (SL). We hypothesize that a prenatal CHD diagnosis is positively correlated with the infant';s likelihood of undergoing induced labor and as a result, longer hospital stay and higher cost of hospitalization for infant and the new mother. The purpose of the study is to determine if a prenatal CHD diagnosis impacts mode of delivery, describe the presence of obstetric (OB) and/or CHD indications for NSD, determine if timing and mode of delivery, when controlled for the severity of prenatally diagnosed CHD, is associated with postnatal clinical length of stay and cost. Methods: Utilizing an institutional database of prenatally diagnosed infants, chart review of medical records of both mother and infants was performed for 182 infants. Infants carried a prenatal diagnosis of CHD and were born between January 1, 2013 and December 31, 2016 at Advocate Children';s Hospital. Exclusion criteria included intrauterine demise, twin gestation and inadequate documentation. All data were reported using descriptive statistics or frequencies based on the level of measurement and normality. Results: Of the included deliveries (31% with genetic anomalies), 76.5% were born via NSD. Of the NSD group, 65% had CHD as the documented reason for NSD. For IOL, 52.6% were done for the sole indication of CHD. 25.8% were for combined OB and CHD reasons, and 21.6% had a sole OB indication. Of mothers presenting in SL, 42.8% delivered via CS, while 32% of IOL mothers went to CS. Infants born via SL, including those scheduled for an induction and born prematurely, were smaller than those born via IOL (mean birth weight 2.81kg vs 3.07kg, p=0.014) and born earlier (mean gestational age 37 3/7 weeks vs 38 2/7 weeks, p=0.006). There was no difference between total length of stay (LOS) between SL and IOL for mother or infants, but a greater portion of the mother';s hospital stay was before delivery with IOL vs SL (median 15.3 hours vs. 5.3 hours, pp There was no significant difference in the severity of CHD among the different modes of delivery. Conclusi