Foetal congenital heart disease: obstetric management and time to first cardiac intervention in babies delivered at a tertiary centre

Jowett, Victoria; Sankaran, Srividhya; Rollings, Sherrida; Hall, Richard F.; Kyle, Pippa; Sharland, Gurleen

doi:10.1017/s1047951113000681

Cited by 19 publications

(11 citation statements)

References 20 publications

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“…Therefore, for most cases of CHD, vaginal delivery rather than scheduled cesarean delivery can be attempted because there is usually no need for immediate cardiac intervention after delivery [16].…”

Section: Congenital Heart Diseasementioning

confidence: 99%

“…Pregnant women carrying a fetus with fetal arrhythmias whose fetal heart rate during labor and delivery cannot be monitored adequately to reassure fetal wellbeing may need to be delivered by cesarean section. In addition, fetuses with established compromise such as those with fetal hydrops and growth restriction, especially when they cannot tolerate labor, may benefit from being delivered by cesarean section instead of having to undergo long inductions [16].…”

Section: Fetal Cardiac Arrhythmiasmentioning

confidence: 99%

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Delivery modes in case of fetal malformations

Wataganara

Grünebaum

Chervenak

et al. 2017

Journal of Perinatal Medicine

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An estimated 276,000 babies die within 4 weeks of birth every year, worldwide, from congenital anomalies. Better quality ultrasound screening can increase the detection of these fetal malformations in the prenatal period. Prenatal counseling for the pregnant woman and her family, regarding the nature of the disease and prognosis is necessary. Options for management in prenatal, perinatal, intrapartum, neonatal, and childhood periods need to be thoroughly discussed, so that the family can make an informed decision. A multidisciplinary approach is usually needed once a decision has been made to optimize fetal outcome, to plan for the timing and location as well as the mode of delivery. In most of the cases, vaginal delivery can be attempted. An elective cesarean delivery should be reserved for maternal concern of dystocia, certain fetal conditions that cesarean delivery will optimize perinatal outcome, or if the parents have a psychosocial determination to have a live-born infant.

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Section: Congenital Heart Diseasementioning

confidence: 99%

Section: Fetal Cardiac Arrhythmiasmentioning

confidence: 99%

Delivery modes in case of fetal malformations

Wataganara

Grünebaum

Chervenak

et al. 2017

Journal of Perinatal Medicine

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“…Most of the pregnancies with foetuses heart defects should have vaginal deliveries in the third degree reference center however there is no direct translation into the follow-up of the newborns 25 .…”

confidence: 99%

Absent Pulmonary Valve Syndrome – Special Prenatal Care and Early Surgery in Obstetric/Cardiac Center - A New Hope for Postnatal Survivors?

Zych-Krekora

Krekora

Kopala

et al. 2017

Prenatal Cardiology

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Introduction: APVS (Absent Pulmonary Valve Syndrome) is a rare congenital heart disease. Its incidence according to The Polish National Registry of Fetal Cardiac Pathology in years 2004 - 2016 was 0.6%.This disease is caused by the absence or the residual pulmonary artery valve resulting in significant dilation of the pulmonary trunk and its branches. In utero deaths are reported. After birth the major problem is respiratory failure and high preoperative and postoperative mortality. Material and methods: In 1995 to 2016, 11 fetuses with APVS were diagnosed in our unit, at the average 27,5 weeks of gestation (min. 18.5- max 37.1 weeks of gestation). Two groups were analysed in this series of cases: “Old one” by 2011 (n = 6) and “New one” since 2011 (n = 5) and perinatal care as well as survival were compared. We analysed the fetal echo results, perinatal care including transplacental digoxin and steroids treatment in NEW group, the longevity of the pregnancy and neonatal/infants outcome. Results: In Old group the average day of cardiac surgery was day 91st after birth (max. 161) and the survival was 50% . In the New group the average surgery day was 41st day and the postoperative survival was 60%, however there was no statistical significance ( p > 0,05). Conclusions: There is no single parameter from prenatal life in foetuses with APVS which may allow to predict the positive outcome meaning neonatal survival. However optimal perinatal care (early detection of defect, transplacental digoxin at least 3-4 weeks, steroids, no preterm delivery, on-time delivery, postnatal care in tertiary center) and relatively early cardiac surgery may have combined impact on the improvement of survival after prenatal diagnosis of APVS, however more data are necessary to prove this hypothesis.

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“…Unfortunately, prenatal diagnosis can often lead to premature delivery at <37 weeks and higher rates of cesarean with no evidence of improved survival [73e75]. In fact, several studies have now shown that a vaginal delivery at term is preferred and elective cesarean should only be reserved for cases with a high likelihood for immediate postnatal intervention [76,77]. Perinatal and immediate postnatal management of fetuses with congenital birth defects are based on severity of fetal diagnosis, level of care needed, access to specialists, likelihood for rapid decompensation (hemodynamic instability) and need for immediate postnatal intervention with a lifesaving procedure.…”

Section: Perinatal Decision-making For Optimal Postnatal Transitionmentioning

confidence: 99%

Clinical relevance of fetal hemodynamic monitoring: Perinatal implications

Pruetz

Votava‐Smith

Miller

2015

Seminars in Fetal and Neonatal Medicine

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Foetal congenital heart disease: obstetric management and time to first cardiac intervention in babies delivered at a tertiary centre

Abstract: Vaginal delivery can be achieved in women delivering babies with major congenital heart disease at a tertiary centre. Delivery in or near a tertiary centre is recommended for patients requiring early intervention, of which many can be identified in advance.

Cited by 19 publications

References 20 publications

Delivery modes in case of fetal malformations

Delivery modes in case of fetal malformations

Absent Pulmonary Valve Syndrome – Special Prenatal Care and Early Surgery in Obstetric/Cardiac Center - A New Hope for Postnatal Survivors?

Clinical relevance of fetal hemodynamic monitoring: Perinatal implications

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