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PL.25 Prenatal Diagnosis of Congenital Heart Disease: Effect on Labour Progress and Mode of Delivery
  1. A McTiernan1,
  2. S Farrell1,
  3. CA Walsh2,
  4. C Mulcahy2,
  5. C McMahon3,
  6. FM McAuliffe2,4
  1. 1Medical Student, University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland
  2. 2Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland
  3. 3Department of Paediatric Cardiology, Our Lady’s Hospital for Sick Children, Dublin, Ireland
  4. 4University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland

Abstract

Objective To compare mode of delivery in fetuses with known congenital heart disease (CHD) versus the background rate in non-anomalous fetuses.

Methods We examined all cases of prenatally-diagnosed CHD over the 5-year study period, 2007–2011. Data were extracted from computerised patient records. Control data for non-anomalous fetuses were obtained from published hospital records for 2007. Categorical data were analysed using Fisher’s exact test (5% level significant).

Results We identified 242 cases of prenatally-diagnosed CHD over the study period. We excluded 25 lethal karyotypes, 7 miscarriages and 1 termination. Of the remaining 209 cases, complete labour records were available for 158 women. There were 146 live births (92%) and 12 antepartum stillbirths at ≥24 weeks (8%). Of the live-born infants with CHD, the perinatal mortality rate was 41 per 1,000. Extra-cardiac defects and non-lethal karyotypic abnormalities were present in 22% (n = 34) and 11% (n = 18) of the cohort respectively. Overall, 23% (34/146) underwent elective caesarean section (CS). The remaining 112 women had a trial of labour, with a 13% (n = 15) intrapartum CS rate. The rate of intrapartum CS for nulliparous women with known CHD was 18% (8/45), which was not different to the rate in nulliparous controls in 2007 (13%; 432/3324; p = 0.27). The equivalent rate in multiparous women was 10% (7/67) in CHD versus 2.4% (80/3392) in controls without previous CS (p = 0.0013).

Conclusions The rate of intrapartum CS in fetuses with known CHD is not different to the background rate in nulliparous women but is increased in multips.

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