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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global birth prevalence of congenital heart defects 1970–2017: updated systematic review and meta-analysis of 260 studies.Int J Epidemiol. 2019; 48: 455-463
- Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally.Am J Cardiol. 1999; 83: 1649-1653
- Prenatal diagnosis of congenital heart disease and birth outcomes.Pediatr Cardiol. 2013; 34: 597-605
- Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome.Arch Dis Child Fetal Neonatal. 2007; 92: 199-204
- Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity.Heart. 2002; 87: 67-69
- Prenatal diagnosis of transposition of great vessels reduces neonatal morbidity and mortality.Arch Mal Coeur Vaiss. 1999; 92: 637-640
- Geographic distribution of physicians in Canada: beyond how many and where.Ottawa Can Inst Heal Inf, 2005: 11
- Induction of labour for improving birth outcomes for women at or beyond term.Cochrane Database Syst Rev. 2012; : CD004945
- Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease.Pediatrics. 2010; 126: 277-284
- Congenital heart disease infant death rates decrease as gestational age advances from 34 to 40 weeks.J Pediatr. 2011; 159: 761-765
- Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the society of thoracic surgeons congenital heart surgery database.Circulation. 2014; 129: 2511-2517
- Effect of fetal growth on 1-year mortality in neonates with critical congenital heart disease.J Am Heart Assoc. 2018; 7: 1-12
- Impaired fetal environment and gestational age: what is driving mortality in neonates with critical congenital heart disease?.J Am Heart Assoc. 2019; 8: 1-10
- Neonatal encephalopathy and neurologic outcome.Obstet Gynecol. 2014; 123 (Washington, DC): 896-901
- A randomized trial of intrapartum fetal ECG ST-segment analysis.N Engl J Med. 2015; 373: 632-641
- Labor induction versus expectant management in low-risk nulliparous women.N Engl J Med. 2018; 379: 513-523
- Outcome after prenatal and postnatal diagnosis of complex congenital heart defects and the influence of genetic anomalies.Prenat Diagn. 2017; 37: 983-991
- Clinical outcomes of near-term infants.Pediatrics. 2004; 114: 372-376
- Pregnancy outcomes associated with intrauterine growth restriction.Am J Obstet Gynecol. 2003; 188: 1596-1601
- The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes.Diabetes Care. 2012; 35: 780-786
- Timing of elective repeat cesarean delivery at term and neonatal outcomes.N Engl J Med. 2009; 360: 111-120
Article info
Publication history
Published online: May 19, 2022
Accepted:
March 21,
2022
Received:
December 4,
2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
Each author has indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
