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

Published online by Cambridge University Press:  13 June 2013

Victoria C. Jowett ,
Srividhya Sankaran ,
Sherrida L. Rollings ,
Richard Hall ,
Pippa M. Kyle  and
Gurleen K. Sharland
Victoria C. Jowett
Affiliation:
Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom
Srividhya Sankaran
Affiliation:
Department of Fetal Medicine, Evelina Children's Hospital, London, United Kingdom
Sherrida L. Rollings
Affiliation:
Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom
Richard Hall
Affiliation:
Department of Cytogenetics, GSTS Pathology, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
Pippa M. Kyle
Affiliation:
Department of Fetal Medicine, Evelina Children's Hospital, London, United Kingdom
Gurleen K. Sharland*
Affiliation:
Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom
*
Correspondence to: Dr G. Sharland, Guy's and St Thomas’ NHS Foundation Trust, Evelina Children's Hospital, Westminister Bridge Road, London SE1 7EH, United Kingdom. Tel: +02 071 88 2308; Fax: +02 071 88 2307; E-mail: Gurleen.Sharland@gstt.nhs.uk
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Abstract

Objectives: The aim of this study was to determine the timing of neonatal cardiac intervention in babies with antenatally diagnosed congenital heart disease and the impact on obstetric management. Methods: A retrospective review of all deliveries between January, 2008 and December, 2009 was conducted in a tertiary centre with foetal and paediatric cardiology, maternal–foetal medicine, and obstetric units. All live births with antenatally detected congenital heart disease were included. Data were collected from foetal, paediatric cardiology, and maternity databases and records. Induction, delivery mode, and timing of the first cardiac intervention in the neonate were studied. Results: 205 deliveries were included. Induction and elective Caesarean section rates were 51.2% (105/205) and 14.1% (29/205), respectively. The vaginal delivery rate was 56% (115/205). There was a non-significant trend towards a higher rate of vaginal delivery after spontaneous labour than after induction (75% versus 66%; p = 0.234). The rate of neonatal cardiac intervention during the initial stay was 59.5% (122/205); it was 18.5% (38/205) within 48 hours and 25.8% (53/205) within 72 hours. The median time to first intervention was 4 days (interquartile range 2–8). Babies with hypoplastic left heart syndrome (median 3, interquartile range 2–6), transposition of the great arteries (median 1, interquartile range 0–4.5), and arrhythmia (median 0.5, interquartile range 0–1) had a significantly earlier time to first intervention compared with those with other conditions (p = 0.001). Conclusion: 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.

Keywords

Foetuscongenital heart diseasemode of deliveryneonatal cardiac surgeryfirst interventiondelivery at tertiary centre
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 494 - 502
Copyright
Copyright © Cambridge University Press 2013 

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