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To examine the role of attempted route of delivery on neonatal outcomes in fetuses with congenital cardiac anomalies.
Singleton and multiple gestations with fetal cardiac anomalies and delivery greater than 34 weeks were analyzed from the Consortium on Safe Labor, a retrospective cohort study of electronic medical records. Fetal cardiac anomalies were determined using ICD 9 codes and organized based on morphology. Cases with more than one cardiac defect were analyzed in each group. Stillbirths and aneuploidies were excluded. Neonatal outcomes were determined for each type of fetal cardiac anomaly. Composite neonatal morbidity (serious respiratory morbidity, sepsis, birth trauma, hypoxic ischemic encephalopathy, and neonatal death) was compared between attempted vaginal delivery (VD) and planned cesarean delivery (CD) for prenatal and postnatal diagnosis. We used multivariate logistic regression to calculate adjusted odds ratio (aOR) for composite neonatal morbidity controlling for race, parity, BMI, insurance, gestational age, maternal disease, single or multiple anomalies, and maternal drug use.
There were 2,166 neonates with 2,701 fetal cardiac anomalies. Rates of cardiac anomaly prenatal diagnosis were generally similar to rates reported in the literature with the majority not diagnosed prenatally (Table). Neonatal death occurred in 8.4% of 107 neonates with conotruncal defects. Serious respiratory morbidity occurred in 56.2% of 89 neonates with left ventricular outflow tract defects. In our cohort 76.3% of 2,166 neonates underwent attempted VD and 23.7% planned CD. Planned CD compared to attempted VD was not associated with decreased composite neonatal morbidity for all prenatally diagnosed (aOR 0.99, 95% CI 0.77-1.27) as well as postnatally diagnosed fetuses (aOR 1.67, 95% CI 0.86-3.24).
The majority of fetal cardiac anomalies were not prenatally diagnosed and were associated with increased rates of neonatal morbidity. Planned cesarean delivery for fetal cardiac anomalies was not associated with decreased neonatal morbidity.