Delivery Outcome of Fetuses with Congenital Heart Disease—Is It Influenced by Prenatal Diagnosis?

Abstract

Objective: The objective of this study is to assess the delivery outcomes of neonates with congenital heart defects (CHD), and to explore the effect of prenatal diagnosis on these outcomes. Methods: A retrospective study including singleton deliveries between 2011 and 2020. All singleton neonates delivered at >24 weeks of gestation were included in this study. Fetuses with known prenatal anomalies other than CHD were excluded from this study. Pregnancy and neonatal outcomes were analyzed. A comparison was made between pregnancies with CHD and controls; and between pregnancies with prenatal diagnosis of CHD and postnatal diagnosis of CHD. Results: A total of 1598 neonates with CHD (688, 43.1% diagnosed prenatally) comprised the study group, compared to 85,576 singleton controls. Pregnancies with CHD had significantly increased BMI before pregnancy, suffered more from diabetes and chronic hypertension, had more inductions of labor, and had more cesarean deliveries (CD) including both elective CD and urgent CD due to non-reassuring fetal monitor (NRFHR) (OR = 1.75; 95%CI 1.45–2.14). Prenatal diagnosis of CHD is associated with a significant increased rate of induction of labor compared to postnatal diagnosis of CHD (OR = 1.59; 95% CI 1.15–2.22), but did not affect the mode of delivery including the rate of CD and CD due to non-reassuring fetal heart rate (NRFHR). Gestational age at birth and birthweight were significantly lower in pregnancies with CHD compared to controls, with no difference between prenatal to postnatal diagnosis of the anomaly. Neonates with CHD had a higher incidence of hypoxic ischemic encephalopathy and seizures compared to controls without any impact by prenatal diagnosis. Conclusion: Prenatal diagnosis of CHD is associated with an increased rate of induction of labor, with no increased rate of CD and CD due to NRFHR. The 5-min Apgar score is lower in pregnancies with postnatal diagnosis of CHD.

Comparison of Apgar scores and cord blood gas parameters in fetuses with isolated congenital heart disease and healthy controls

“…This can result in lower Apgar scores and worsened umbilical blood gas parameters. Previous studies demonstrated that neonates with CHD tend to have higher rates of Apgar scores of less than 7 or umbilical cord blood gas pH less than 7.00 compared to healthy controls (Weissmann-Brenner et al, 2022). Additionally, impaired results may be used to predict mortality in a defined time interval.…”

Delivery room and early postnatal management of neonates with congenital heart disease

“…The Neonatal Resuscitation Program (NRP) guidelines were created for delivery room (DR) care of all newborns and are not diagnosis‐specific, including being used for the resuscitation of newborns with CHD 10 . Most CHD does not require alterations in the neonatal resuscitation algorithm for stabilization; however, for newborns with specific CCHD, NRP guidelines are inadequate and potentially detrimental and therefore need modification 11,12 . With a fetal diagnosis, neonatal providers can change standard care and use recommendations based on the CHD diagnosis to prepare and incorporate NRP modifications for stabilization 11,13–18 .…”

“…10 Most CHD does not require alterations in the neonatal resuscitation algorithm for stabilization; however, for newborns with specific CCHD, NRP guidelines are inadequate and potentially detrimental and therefore need modification. 11,12 With a fetal diagnosis, neonatal providers can change standard care and use recommendations based on the CHD diagnosis to prepare and incorporate NRP modifications for stabilization. 11,[13][14][15][16][17][18] This review highlights the use of prenatal diagnosis for pre-delivery, DR planning, modifications in resuscitation, and immediate postnatal stabilization for neonates with CHD.…”

“…11,12 With a fetal diagnosis, neonatal providers can change standard care and use recommendations based on the CHD diagnosis to prepare and incorporate NRP modifications for stabilization. 11,[13][14][15][16][17][18] This review highlights the use of prenatal diagnosis for pre-delivery, DR planning, modifications in resuscitation, and immediate postnatal stabilization for neonates with CHD.…”

Fetal Heart Diseases and Neonatal Mortality: Risk Factors and Management

“…General prenatal screening reduces mortality in the rst year of life [11]. Delivery-related factors such as the type of delivery, the type of cesarean delivery (elective or urgent) and induction of labor have been investigated in many studies in pregnancies with fetal heart disease [8, [12][13][14][15]. Previous studies have concluded that vaginal delivery is safe for fetuses with heart disease.…”