777: Timing of delivery in women with cardiac disease

Abstract

Timing of delivery for women with cardiovascular disease (CVD) is one question for which standard guidelines do not exist. The neonatal benefit of a term delivery as compared to an early term delivery is well described. We sought to examine maternal outcomes in women with cardiac disease who delivered in the early term period (37+0 weeks through 38+6 weeks) compared with those who delivered later. This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal and obstetric characteristics were evaluated. Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of hypertension (18.1% vs 7%, p=0.01) and intrauterine growth restriction (22.9% vs 2.8%, p<0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8% vs 3.5%, p=0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4% vs 24.7%, p=0.004). There is no maternal benefit of an early term delivery in women with cardiac disease. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)