744: Obstetric characteristics associated with fetal cyanotic congenital heart disease

Abstract

Fetal cyanotic congenital heart disease (CCHD) is associated with pregnancy complications such as preterm birth (PTB), fetal intolerance of labor (FIOL) and cesarean delivery (CD). CD is usually reserved for standard obstetric indications. We sought to characterize obstetric factors associated with CCHD over a 10-year period. Population-based retrospective cohort study of all livebirths in Ohio (2006-2015). Obstetric and delivery characteristics were compared between live births with CCHD (excluding other anomalies and aneuploidy), as reported in the birth certificate, to those without. Multivariate logistic regression estimated the relative influence of CCHD on obstetric outcomes. Of 1,425,334 live births in Ohio during the 10-year study period, 863 (0.06%) women delivered an infant with CCHD. Women with CCHD pregnancies were more likely to have pre-gestational diabetes, gestational diabetes, be induced, and deliver at an academic center. The CD rate was 45.9 vs 31.0% (p<0.001) in pregnancies with CCHD compared to those without CCHD, however among women induced there was no difference in successful vaginal birth (83.6 vs 82.2, p=0.528) between groups respectively. Delivery of an infant with CCHD was associated with a higher rate of PTB (22.1 vs 12.4%, p<0.001), fetal growth restriction (FGR, <10th%), (22.2 vs 10.5%, p<0.001) and intrapartum FIOL (17.2 vs 8.5%, p<0.001). In women with a singleton, vertex presenting fetus with isolated CCHD and no prior history of CD, 68.0 vs 44.7% (p<0.001; OR 2.6, 95% CI 1.9-3.6) did not attempt a trial of labor (TOL) compared to non-CCHD pregnancies prior to cesarean birth. As the frequency of inductions in the latter 5 years (2011-2015) of the study period increased from 30.8 to 43.8% (p=0.001) among CCHD pregnancies, the CD rate decreased (41.6 vs 33.3%, p<0.031) in women without a history of CD. The rate of cesarean in CCHD births is high at 45.9%. Obstetric characteristics associated with CCHD include higher risk for PTB, FGR, CD, and FIOL. While women with CCHD pregnancies were more likely to be induced, over two thirds of those who would otherwise be vaginal delivery candidates did not attempt a trial of labor despite successful vaginal birth in greater than 80% of those induced. Avoidance of planned cesarean birth for CCHD affords an opportunity to reduce the overall cesarean rate in low risk women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)