Abstract
Objective: The influence of prenatal congenital heart disease (CHD) detection on obstetric outcomes and the impact of mode of delivery on neonatal outcomes is unclear. We hypothesized that prenatal detection would increase the number of scheduled deliveries and would decrease time to neonatal surgery and hospital length of stay. Methods: A retrospective review of all infants who underwent surgical repair of CHD prior to NICU discharge from Morgan Stanley Children’s Hospital of New York (CHONY) from 1/04 −1/08 was conducted. Results: Of 439 neonates, 294 (67%) were diagnosed prenatally (PREdx), 244 (55.6%) were born at CHONY, 150 (34.2%) delivered by unscheduled vaginal delivery (VD), 123 (28.1%) by induced vaginal delivery (IVD), and 182 (41.5%) by Cesarean delivery (CD). Compared to postnatal diagnosis (POSTdx), PREdx increased odds of delivery at CHONY (81.6% vs 2.7%, OR 156.7; 95% CI 55.6–441.8, p < 0.001) and IVD (40.1% vs 3.5%, OR 18.7; 95% CI 7.5–47.2, p < 0.001) and decreased odds of a weekend birth (11.2% vs 19.3%, OR 0.53; 95% CI 0.3–0.9, p = 0.02) and VD (24.5% vs 54.2%, OR 0.28; 95%CI 0.18–0.42, p < 0.001). CD rate did not differ between groups (119/294 (40.4%)PREdx vs 63/144 (43.7%)POSTdx, p = 0.55), while PREdx decreased odds of conversion to CD from VD(8.8% vs 16%, OR 0.52; 95% CI 0.28–0.94, p < 0.036). Infants with PREdx had lower mean gestational age (GA) (37.9 ± 2 vs 38.6 ± 2 wk, p < 0.001) and birth weight (BW) (3.0 ± 0.62 vs 3.1 ± 0.63 kg, p = 0.002) than those with POSTdx. Neither mode of delivery nor PREdx impacted time to neonatal surgery or hospital length of stay. Conclusions: Fetal CHD diagnosis strongly influences peri-partum decisions but is not associated with an increased CD risk. Mode of delivery is associated with decreased GA and BW but does not impact neonatal time to surgery. Our next challenge is to translate prenatal CHD diagnosis into shortened time to surgery and length of stay.
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