Advertisement

Pediatric Cardiology

, Volume 38, Issue 3, pp 588–595 | Cite as

Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC)

  • Shabnam PeyvandiEmail author
  • Tina Ahn Thu Thi Nguyen
  • Myriam Almeida-Jones
  • Nina Boe
  • Laila Rhee
  • Tracy Anton
  • Mark Sklansky
  • Maryam Tarsa
  • Gary Satou
  • Anita J. Moon-Grady
  • For The University of California Fetal Consortium (UCfC)
Original Article

Abstract

Prenatal diagnosis of critical congenital heart disease (CHD) is associated with decreased morbidity. It is also associated with lower birth weights and earlier gestational age at delivery. The University of California Fetal Consortium (UCfC) comprises five tertiary medical centers, and was created to define treatment practices. We utilized this consortium to assess delivery patterns and outcomes in subjects with prenatal and postnatal diagnosis of CHD. A retrospective cohort study was conducted on maternal–neonatal pairs diagnosed with complex CHD prenatally (n = 186) and postnatally (n = 110) from 2011 to 2013. Outcomes were assessed between groups after adjusting for disease severity. Prenatally diagnosed subjects were born earlier (38.1 ± 0.11 vs. 39 ± 0.14 weeks, p = < 0.001), and had lower birth weights (2853 ± 49 vs. 3074 ± 58 g, p = 0.005) as compared to postnatal diagnosis. For every week increase in gestational age and 100 g increase in birth weight, length of stay decreased by 12.3 ± 2.7% (p < 0.001) and 3.9 ± 0.9% (p < 0.001). Subjects with prenatal diagnosis were more often born via cesarean both planned (35.6 vs. 26.2%, p = 0.004) and after a trial of labor (13 vs. 7.8%, p = 0.017). Neonates with cesarean delivery trended toward a longer length of stay (2.6 days longer), and were born earlier as compared to other modalities (37.7 ± 0.22 weeks, p = 0.001). Management after prenatal diagnosis of CHD appears to have modifiable disadvantages for maternal and neonatal outcomes. The UCfC provides a platform to study best practices and standardization of care for future studies.

Keywords

Congenital heart disease Prenatal diagnosis Outcomes 

Notes

Acknowledgements

We would like to thank Jeffrey Gornbein, PhD (UCLA) for his assistance with statistical analysis and review of the manuscript.

Funding

Dr. Peyvandi is supported by the NIH (P01 NS082330).

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was not required in this study due to the d-identified and retrospective nature of the data. A multi-institutional review board reliance registry provided approval for the study (IRB #10-04093).

References

  1. 1.
    Fetal Echocardiography Task Force, American Institute of Ultrasound in Medicine Clinical Standards Committee, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine (2011) AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med 30:127–136.CrossRefGoogle Scholar
  2. 2.
    International Society of Ultrasound in Obstetrics and Gynecology, Carvalho JS, Allan LD et al (2013) ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 41:348–359. doi: 10.1002/uog.12403 CrossRefPubMedGoogle Scholar
  3. 3.
    Tometzki AJ, Suda K, Kohl T, et al (1999) Accuracy of prenatal echocardiographic diagnosis and prognosis of fetuses with conotruncal anomalies. JAC 33:1696–1701.Google Scholar
  4. 4.
    Allan LD, Sharland GK, Milburn A, et al (1994) Prospective diagnosis of 1006 consecutive cases of congenital heart disease in the fetus. JAC 23:1452–1458.Google Scholar
  5. 5.
    Donofrio MT, Moon-Grady AJ, Hornberger LK et al (2014) Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 129:2183–2242. doi: 10.1161/01.cir.0000437597.44550.5d CrossRefPubMedGoogle Scholar
  6. 6.
    Morris SA, Ethen MK, Penny DJ et al (2014) Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation 129:285–292. doi: 10.1161/CIRCULATIONAHA.113.003711 CrossRefPubMedGoogle Scholar
  7. 7.
    Tworetzky W, McElhinney DB, Reddy VM et al (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMedGoogle Scholar
  8. 8.
    Kipps AK, Feuille C, Azakie A et al (2011) Prenatal diagnosis of hypoplastic left heart syndrome in current era. Am J Cardiol 108:421–427. doi: 10.1016/j.amjcard.2011.03.065 CrossRefPubMedGoogle Scholar
  9. 9.
    Mahle WT, Clancy RR, McGaurn SP et al (2001) Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 107:1277–1282CrossRefPubMedGoogle Scholar
  10. 10.
    Kumar RK, Newburger JW, Gauvreau K, et al (1999) Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. AJC 83:1649–1653.CrossRefGoogle Scholar
  11. 11.
    Friedberg MK, Silverman NH, Moon-Grady AJ et al (2009) Prenatal detection of congenital heart disease. J Pediatr 155(26-31-31):e1. doi: 10.1016/j.jpeds.2009.01.050 Google Scholar
  12. 12.
    Oster ME, Kim CH, Kusano AS et al (2014) A population-based study of the association of prenatal diagnosis with survival rate for infants with congenital heart defects. Am J Cardiol 113:1036–1040. doi: 10.1016/j.amjcard.2013.11.066 CrossRefPubMedGoogle Scholar
  13. 13.
    Wright LK, Ehrlich A, Stauffer N et al (2014) Relation of prenatal diagnosis with one-year survival rate for infants with congenital heart disease. Am J Cardiol 113:1041–1044. doi: 10.1016/j.amjcard.2013.11.065 CrossRefPubMedGoogle Scholar
  14. 14.
    Calderon J, Angeard N, Moutier S et al (2012) Impact of prenatal diagnosis on neurocognitive outcomes in children with transposition of the great arteries. J Pediatr 161(94–8):e1. doi: 10.1016/j.jpeds.2011.12.036 Google Scholar
  15. 15.
    Peyvandi S, De Santiago V, Chakkarapani E, et al (2016) Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury. JAMA Pediatr. doi: 10.1001/jamapediatrics.2015.4450 PubMedGoogle Scholar
  16. 16.
    Levey A, Glickstein JS, Kleinman CS et al (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597. doi: 10.1007/s00246-010-9648-2 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Costello JM, Pasquali SK, Jacobs JP et al (2014) Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the society of thoracic surgeons congenital heart surgery database. Circulation 129:2511–2517. doi: 10.1161/CIRCULATIONAHA.113.005864 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Goff DA, Luan X, Gerdes M et al (2012) Younger gestational age is associated with worse neurodevelopmental outcomes after cardiac surgery in infancy. J Thorac Cardiovasc Surg 143:535–542. doi: 10.1016/j.jtcvs.2011.11.029 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Jenkins KJ, Gauvreau K, Newburger JW, et al (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123 110–118CrossRefPubMedGoogle Scholar
  20. 20.
    Fenton TR, Kim JH (2013) A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 13:59. doi: 10.1186/1471-2431-13-59 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Peterson AL, Quartermain MD, Ades A et al (2011) Impact of mode of delivery on markers of perinatal hemodynamics in infants with hypoplastic left heart syndrome. J Pediatr 159:64–69. doi: 10.1016/j.jpeds.2011.01.004 CrossRefPubMedGoogle Scholar
  22. 22.
    Trento LU, Pruetz JD, Chang RK et al (2012) Prenatal diagnosis of congenital heart disease: impact of mode of delivery on neonatal outcome. Prenat Diagn 32:1250–1255. doi: 10.1002/pd.3991 CrossRefPubMedGoogle Scholar
  23. 23.
    Hannah ME, Hannah WJ, Hewson SA et al (2000) Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term breech trial collaborative group. Lancet 356:1375–1383CrossRefPubMedGoogle Scholar
  24. 24.
    Minkoff H, Chervenak FA (2003) Elective primary cesarean delivery. N Engl J Med 348:946–950. doi: 10.1056/NEJMsb022734 CrossRefPubMedGoogle Scholar
  25. 25.
    Silver RM, Landon MB, Rouse DJ et al (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232. doi: 10.1097/01.AOG.0000219750.79480.84 CrossRefPubMedGoogle Scholar
  26. 26.
    Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR (2000) Association between method of delivery and maternal rehospitalization. JAMA 283:2411–2416CrossRefPubMedGoogle Scholar
  27. 27.
    Snyder CC, Wolfe KB, Loftin RW et al (2011) The influence of hospital type on induction of labor and mode of delivery. Am J Obstet Gynecol 205(346):e1–e4. doi: 10.1016/j.ajog.2011.05.004 Google Scholar
  28. 28.
    Seyb ST, Berka RJ, Socol ML, Dooley SL (1999) Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol 94:600–607PubMedGoogle Scholar
  29. 29.
    Maslow AS, Sweeny AL (2000) Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol 95:917–922PubMedGoogle Scholar
  30. 30.
    Cammu H, Martens G, Ruyssinck G, Amy J-J (2002) Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol 186:240–244CrossRefPubMedGoogle Scholar
  31. 31.
    Yeast JD, Jones A, Poskin M (1999) Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol 180:628–633CrossRefPubMedGoogle Scholar
  32. 32.
    Sheiner E, Sarid L, Levy A et al (2005) Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 18:149–154. doi: 10.1080/14767050500170088 CrossRefPubMedGoogle Scholar
  33. 33.
    Vrouenraets FPJM, Roumen FJME, Dehing CJG et al (2005) Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 105:690–697. doi: 10.1097/01.AOG.0000152338.76759.38 CrossRefPubMedGoogle Scholar
  34. 34.
    Kaufman KE, Bailit JL, Grobman W (2002) Elective induction: an analysis of economic and health consequences. Am J Obstet Gynecol 187:858–863CrossRefPubMedGoogle Scholar
  35. 35.
    Allen VM, O’Connell CM, Farrell SA, Baskett TF (2005) Economic implications of method of delivery. Am J Obstet Gynecol 193:192–197. doi: 10.1016/j.ajog.2004.10.635 CrossRefPubMedGoogle Scholar
  36. 36.
    Ueda K, Ikeda T, Iwanaga N et al (2009) Intrapartum fetal heart rate monitoring in cases of congenital heart disease. Am J Obstet Gynecol 201(64):e1–e6. doi: 10.1016/j.ajog.2009.03.015 Google Scholar
  37. 37.
    Morikawa M, Endo D, Yamada T et al (2014) Electronic fetal heart rate monitoring in five fetuses with Ebstein’s anomaly. J Obstet Gynaecol Res 40:424–428. doi: 10.1111/jog.12190 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Shabnam Peyvandi
    • 1
    Email author
  • Tina Ahn Thu Thi Nguyen
    • 2
  • Myriam Almeida-Jones
    • 4
  • Nina Boe
    • 5
  • Laila Rhee
    • 5
  • Tracy Anton
    • 6
  • Mark Sklansky
    • 3
  • Maryam Tarsa
    • 6
  • Gary Satou
    • 3
  • Anita J. Moon-Grady
    • 1
  • For The University of California Fetal Consortium (UCfC)
  1. 1.Division of Pediatric Cardiology and the Fetal Treatment CenterUniversity of California San Francisco Benioff Children’s HospitalSan FranciscoUSA
  2. 2.Department of Obstetrics and Gynecology, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  3. 3.Division of Cardiology, Mattel Children’s Hospital and David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  4. 4.Division of CardiologyUniversity of California Irvine and Children’s Hospital of Orange CountyOrangeUSA
  5. 5.Division of Maternal-Fetal Medicine, Department of Obstetric and GynecologyUniversity of CaliforniaDavisUSA
  6. 6.Division of Maternal Fetal Medicine, Department of Reproductive MedicineUniversity of CaliforniaSan DiegoUSA

Personalised recommendations