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Impact of Planned Delivery on the Perinatal Outcome of Term Fetuses with Isolated Heart Defects

      Abstract

      Objective

      Pregnancies complicated by fetal heart defects often undergo a planned delivery prior to term by either induction of labour or cesarean delivery to ensure optimal availability of neonatal care. We aimed to assess whether such planned deliveries achieve their goal of better perinatal care.

      Methods

      We conducted a retrospective case-control study of pregnancies complicated by isolated fetal cardiac defects, without other fetal comorbidities, managed at a single fetal medicine unit over a 10-year period. Only pregnancies delivered past 37 weeks gestation were included. Patients undergoing elective delivery for care planning reasons only were compared with patients in whom planned delivery was clinically indicated and patients who laboured spontaneously. Obstetric and perinatal outcomes were recorded.

      Results

      Of the 180 pregnancies included in the study, 59 (32.8%) were in the elective group, 49 (27.2%), in the indicated group, and 72 (40%), in the spontaneous group. Mean gestational age at delivery was 39.0 ± 1.1 weeks overall and did not differ between the groups. For the elective group, only 35.6% of deliveries occurred during office hours, which was similar to the 2 other groups. The rate of adverse obstetric or postnatal outcomes was not statistically significantly different between groups.

      Conclusion

      Timed delivery at term does not seem to be associated with an increased risk of poor perinatal outcomes. It may improve perinatal care by providing proximity to a neonatal intensive care unit and convenience for patients and providers.

      Résumé

      Objectif

      En cas de grossesse compliquée par une anomalie cardiaque fœtale, on effectue généralement un accouchement planifié avant terme, par déclenchement artificiel du travail ou césarienne, pour assurer la disponibilité optimale des soins néonataux. Nous avons cherché à déterminer si cette pratique permet effectivement d’améliorer les soins périnataux.

      Méthodologie

      Nous avons mené une étude cas-témoins rétrospective sur les grossesses compliquées par une anomalie cardiaque fœtale isolée, sans autre comorbidité fœtale, qui ont été prises en charge dans une seule unité de médecine fœtale sur une période de 10 ans. Seules les patientes ayant accouché après 37 semaines d’aménorrhée ont été incluses. Le groupe d’accouchement planifié pour optimisation des soins a été comparé au groupe d’accouchement planifié pour indication clinique et au groupe de travail spontané. Les issues obstétricales et périnatales ont été relevées.

      Résultats

      Les 180 grossesses à l’étude ont été réparties comme suit : 59 (32,8 %) dans le groupe d’optimisation des soins; 49 (27,2 %) dans le groupe d’indication clinique; et 72 (40 %) dans celui de travail spontané. Dans l’ensemble, l’âge gestationnel moyen à l’accouchement était de 39,0 SA ± 1,1 j et n’était pas différent entre les groupes. Dans le groupe d’optimisation des soins, seulement 35,6 % des accouchements ont eu lieu pendant le quart de jour, ce qui est semblable au pourcentage des deux autres groupes. Aucune différence statistiquement significative n’a été observée entre les deux groupes pour ce qui est du taux d’issues obstétricales ou postnatales défavorables.

      Conclusion

      L’accouchement planifié à terme ne semble pas être associé à une augmentation du risque d’issues périnatales défavorables. Il peut améliorer les soins périnatals en offrant la proximité d'une unité de soins intensifs néonatals et la commodité pour les patients et les fournisseurs.

      Keywords

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