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J Perinatol. 2014 Dec;34(12):901-5. doi: 10.1038/jp.2014.104. Epub 2014 May 29.

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

Author information

1
Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
2
UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
3
Department of Pediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
4
1] Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland [2] UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.

Abstract

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 45 069 non-anomalous singleton infants ⩾500 g 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.

PMID:
24875409
DOI:
10.1038/jp.2014.104
[Indexed for MEDLINE]

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