Intrauterine fetal demise after prenatal diagnosis of congenital heart disease: assessment of risk

Abstract

IUFD in fetuses with CHD is associated with ECA, genetic syndromes and severe valve regurgitation. In absence of these fetal characteristics, the occurrence of IUFD is low, although it remains higher than in fetuses without CHD.

Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing

“…Among major CHD cases identified prenatally, we confirmed the association of ventricular dysfunction and AV valve regurgitation with the risk of pregnancy loss 10,13,19 . Interestingly, contrary to the findings in the overall cohort, in the prenatal-diagnosis subgroup, oligohydramnios, polyhydramnios and fetal growth restriction were not associated with pregnancy loss on univariable analysis.…”

“…However, the higher risk of pregnancy loss associated with female fetal sex in our cohort contradicts the existing literature. While male sex increases stillbirth risk by 6-10% in the general population 7,43,44 , the association of fetal sex with stillbirth risk in the major-CHD population is less understood and has not been investigated by recent studies 9,10,13 . Further investigation of sex-linked factors may provide insight into the observed male preponderance, phenotypic variability and survivability of the fetus with major CHD 45,46 .…”

Prenatal cardiac care: Goals, priorities & gaps in knowledge in fetal cardiovascular disease: Perspectives of the Fetal Heart Society

“…The goals of fetal cardiac assessment include enhancing the understanding of fetal hemodynamics, predicting outcomes in utero such as fetal demise, identifying requirements for a successful delivery room transition including the need for postnatal interventions, and minimizing postnatal morbidity and mortality [45][46][47][48]. Accurate risk stratification and outcome prediction has been achieved with varying success depending on the lesion often due to limited numbers [45,49,50] and may not always be generalizable from single center studies due to variations in practice. By prioritizing multicenter research and establishing an infrastructure for its conduct (see Research below), the FHS hopes to overcome these limitations.…”

Management of Pregnancy and Delivery in Prenatally Diagnosed Congenital Anomalies

“…Fetuses with cardiac structural anomalies, functional disorders, or arrhythmias that have the potential to compromise tissue oxygen delivery are generally followed with antepartum testing, with intervention if results are abnormal. In one retrospective cohort study, fetuses with a genetic syndrome, extracardiac anomaly, or severe valvular regurgitation were at increased risk for fetal demise: 15/197 (7.6%) fetuses with one or more of these risk factors died in utero versus 3/270 (1%) fetuses without any of these risk factors [9]. Six of the 22 fetal deaths occurred at 20-23 weeks and 16 occurred at 26-41 weeks (including three deaths at 37, 39, and 41 weeks).…”