Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease

Abstract

BackgroundAdvances in cardiac surgery and congenital cardiology have led to an increasing number of women with congenital heart disease (CHD) reaching childbearing age. In general, cardiologists recommend vaginal delivery for women with CHD to avoid complications from Caesarean section as many women with CHD tolerate vaginal delivery well.Methods and ResultsThis is a single-center study comparing mode of delivery, pregnancy outcome, indications for Caesarean section and induction of labor between women with and without CHD. A historical cohort study was conducted including 116 patients with CHD. An individual threefold matching with 348 women without CHD was carried out. Caesarean section was performed in 46.6% of pregnancies with CHD (33.6% without CHD, P = 0.012). Primary Caesarean section increases with severity of CHD (P = 0.036), 33.3% of women with CHD had primary planned Caesarean section due to cardiac reasons. Induction of labor was performed in 45.7% of attempted vaginal deliveries in women with CHD (27.9% without CHD, P = 0.001). Lower mean birth weight (P = 0.004) and Small for Gestational Age (SGA) (P < 0.001) were more common in women with CHD. One CHD patient suffered from postpartum hemorrhage.ConclusionsConcerns about maternal deterioration resulting in higher rates of induction of labor seem unjustified in most cases. Along with a possible reduction of Caesarean section on maternal request, a reduction of planned vaginal delivery may be expedient in reducing the rate of Caesarean section in women with CHD.

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

“…Although an increased prevalence of these coexisting conditions at baseline potentially due to older maternal age at conception may have explained the increased cesarean section rates among women with CHD, the prevalence of these disorders in our CHD group was not higher than worldwide prevalence estimates . A German cohort study reported increased cesarean section rates among women with CHD despite them having less preeclampsia and diabetes than controls . In addition, obstetric conditions represented only 37.5% of indications for primary cesarean section in women with CHD, whereas these conditions constituted 84.3% of indications in controls .…”

“…Women with CHD had more cesarean deliveries than those without. Several other investigators have also found higher cesarean section rates among women with CHD when compared to pregnant controls . This trend may have further progressed since the cesarean delivery rates within the National Inpatient Sample in the United States from 2000 through 2010 were 40.7% (95% CI [39.7, 41.6]) and 32.3% (95% CI [32.2, 32.3]) among women with and without CHD, respectively .…”

The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – a Retrospective Study

“…[1,14,17,25] There were significantly more deliveries by Caesarean section and fewer normal vaginal deliveries in our GUCH cohort, which compares to the reported literature. [1,14,17,25] There was no excess of obstetric complications in our GUCH pregnancy cohort when compared to non-CVD women ( Table 4). These findings are similar to those reported in the Canadian study by Siu et al [14], the German study by Hrycyk et al [25] and those stemming from the Registry Of Pregnancy And Cardiac disease (ROPAC).…”

“…[1,14,17,25] There was no excess of obstetric complications in our GUCH pregnancy cohort when compared to non-CVD women ( Table 4). These findings are similar to those reported in the Canadian study by Siu et al [14], the German study by Hrycyk et al [25] and those stemming from the Registry Of Pregnancy And Cardiac disease (ROPAC). [17] Conversely, in their nationwide U.S. study from 2015, Thompson et al found the odds of several obstetric complications, including gestational diabetes, preterm labour, placental abruption and postpartum haemorrhage, to be significantly higher among delivery hospitalisations for women with CHD.…”

“…This observation has been documented by several other studies. [17,25,27] Maternal cyanosis and poor cardiac output are recognized as the main risk factors for foetal growth restriction and lower birth weights. [27] The fact that, on the whole, our GUCH cohort consisted of women with good saturations and satisfactory cardiac output at baseline, and that use of medications linked with IUGR was minimal, suggests that there might be other less well-recognized factors coming into play to interfere with foetal growth in mothers with CHD.…”