Neonatal and maternal outcomes of pregnancies with a fetal diagnosis of congenital heart disease using a standardized delivery room management protocol

Adams, April; Aggarwal, Nimisha; Fries, Melissa H.; Donofrio, Mary T.; Iqbal, Sara

doi:10.1038/s41372-019-0528-1

Cited by 12 publications

(5 citation statements)

References 31 publications

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“…Similar to our study, Adams et al, in their study on 134 pregnancies with CHD, demonstrated that there was no difference in the umbilical artery PH in the CHD group vs. the control group. They concluded that the circulatory alterations that occur as a result of CHD are well tolerated in utero [ 18 , 19 ]. Levey et al, in their study on 439 neonates with CHD, found no difference in Apgar scores between prenatal and postnatal diagnosis [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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

Weissmann-Brenner

Domniz

Meyer

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Weissmann-Brenner

Domniz

Meyer

et al. 2022

JCM

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“…Fetal echocardiography helps with the prenatal diagnosis of CHDs and serial evaluation during pregnancy, allowing prediction of the risk of hemodynamic instability in the immediate newborn period. Several authors have proposed methods for classifying prenatally diagnosed CHDs to stratify perinatal care requirements based on their fetal echocardiographic features [7][8][9][10][11]. Fetal cardiology guidelines published by the American Heart Association outline a risk-stratification scheme for perinatal and delivery room cardiac care using fetal echocardiographic criteria [13] as described below and summarized in Table 1.…”

Section: Models For Risk-stratification Of Perinatal Care In Newborns...mentioning

confidence: 99%

“…While a select group of high-risk CHD cases may necessitate delivery by a cesarean section to ensure fetal well-being or cardiac team availability, vaginal delivery is safe for most of the other CHD lesions. Studies have shown that rates of cesarean sections and risk of hemodynamic complications in the delivery room for complex CHD fetuses are comparable to healthy fetuses with the help of multidisciplinary care coordination and the use of standardized delivery room management protocols [9]. Although the risk of neonatal acidosis in CHD infants is similar to non-CHD infants for shorter duration of vaginal deliveries, prolonged vaginal delivery in CHD fetuses showed declining median umbilical cord blood Ph as labor progressed [75].…”

Section: Mode Of Delivery In Chd Fetusesmentioning

confidence: 99%

“…With advances in diagnostic imaging and improved obstetrical ultrasound guidelines [3], prenatal diagnosis of CHDs has improved in recent years [4][5][6]. Accurate prenatal assessment by fetal echocardiography and individualized, echocardiography-based perinatal management plans have improved both pre-and postnatal clinical outcomes in the CHD population [7][8][9]. A multidisciplinary team strategy that includes collaboration amongst fetal cardiologists, maternal-fetal medicine specialists, neonatologists, and other clinical services is ideal for implementing effective perinatal management plans for newborns with prenatal diagnosis of CHDs [8].…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning

Patel,

Michelfelder

2024

JCDD

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Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns’ hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.

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“…[51] Early diagnosis of CHD can improve the outcome for neonatal patients through the above-described prenatal diagnosis techniques, combined with multidisciplinary management. A retrospective cohort study of neonates prenatally diagnosed with CHD, by Adams et al [52] in 2020, demonstrated that with collaborative multidisciplinary care, fetuses with a prenatal diagnosis of CHD are similar to healthy fetuses with respect to their cesarean rates, labor and delivery management, and delivery room compromises. Similarly, Qiu et al [53] retrospectively evaluated the value of prenatal CHD diagnosis by comparing pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

Jiang

Wang

et al. 2023

Cardiology Discovery

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With the growing influence of slow population growth and population aging, China has established the birth policy and issued a series of documents to promote maternal and fetal health and improve the birth rate. With the increase in prevalence of birth defects, timely diagnosis and intervention in utero provide possibilities to reduce unnecessary abortions and offer better prognosis. Congenital heart disease (CHD), as one of the most common congenital birth defects, is the leading cause of mortality in patients aged <5 years, and brings a heavy burden to both the affected families and society. Fetuses with CHD are associated with an increased risk of pregnancy-related complications and premature birth, and children with CHD typically face growth and developmental problems even after the correction of malformation. Therefore, management including diagnosis, treatment, and rehabilitation throughout the fetal period into childhood and even adulthood is essential for children with CHD. Based on the rapid advances in intrauterine and perinatal medicine and an in-depth collaboration among obstetrics and pediatrics, a novel diagnosis and treatment system has been established for the management of CHD in the past 2 decades in Shanghai Xinhua Hospital. This Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease model provides prenatal diagnosis, intrauterine intervention, delivery room service and neonatal therapies, and postintrauterine rehabilitation for children with CHD. We have developed a four-dimensional spatiotemporal image correlation echocardiography and a three-dimensional cardiac virtual endoscopy system for the intrauterine diagnosis of CHD, dramatically raising the diagnostic utility. Our innovative and independent newborn-intervention technique has effectively reduced the re-intervention rate in patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. In 2018, Xinhua Hospital independently performed the case of fetal aortic valvuloplasty in Asia through a multidepartment collaborative effort. All children treated in this system achieved biventricular circulation and a better long-term postoperative outcome. We also have conducted postoperative rehabilitation therapy to promote the development and health of children with CHD. The practice of Xinhua model has reduced unnecessary abortion of CHD fetuses, reduced the mortality rate associated with critical CHD, and improved the mid- and long-term prognosis in CHD, which is essential to promote the fertility level and children’s health. Furthermore, translational medicine platform and the birth cohort Early Life Plan was constructed to explore the origins of major developmental diseases and establish an early intervention model in CHD. This practice of assessment of the intrauterine system has been expanded to other congenital defects in Xinhua Hospital, and sequential treatment of more than 2,000 cases has been completed to date. Based on practice in intrauterine management of CHD and other diseases, the concept of Intrauterine Pediatrics was proposed as a first to emphasize early prevention and intervention of childhood diseases and promote a comprehensive lifecycle service for children. The development and evolution of this system requires further attention not only from researchers but also from the government and global medical communities.

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Neonatal and maternal outcomes of pregnancies with a fetal diagnosis of congenital heart disease using a standardized delivery room management protocol

Cited by 12 publications

References 31 publications

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

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

Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning

The Construction of an Intrauterine Diagnosis and Treatment System and Comprehensive Lifecycle Health Service of Congenital Heart Disease: Xinhua Hospital Model

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