Antepartum management and obstetric outcomes among pregnancies with Down syndrome from diagnosis to delivery.

Abstract

Little is known about the obstetric care of an ongoing pregnancy with trisomy 21. We sought to ascertain an obstetric profile for pregnancies with Down syndrome to help guide prenatal management. Pregnancies managed for delivery with trisomy 21 between 2003 and 2014 were analyzed. We reviewed demographic data, diagnostic testing, prenatal surveillance, obstetric outcomes, and placental pathology. T-test, chi-squared test, and Fisher correction were used as indicated. Sixty-eight pregnancies were identified, and four women (5.9%) experienced a loss during the pregnancy. Among the remaining 64 pregnancies, the average gestational age at delivery was 36.9weeks, growth restriction was present in 12 (17.5%), and major anomalies were present in 51 (75.0%). Delivery was undertaken for non-reassuring fetal surveillance in 35.9% of the pregnancies; 93% of which represented a change from prior reassuring surveillance and 52.6% of which demonstrated histopathologic evidence of placental insufficiency. None among increased maternal age, the presence of an anomaly, or growth restriction were significantly more common in the group with non-reassuring surveillance. There are high rates of fetal growth restriction, delivery for non-reassuring fetal status, and evidence of placental insufficiency among affected pregnancies, suggesting a role for antepartum surveillance. © 2017 John Wiley & Sons, Ltd.