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Maternal and neonatal factors associated with cesarean delivery in a cohort of pregnancies complicated by prenatally diagnosed congenital heart disease

Journal of Perinatology volume 44, pages 360–365 (2024)Cite this article

Subjects

Abstract

Background

Pregnancies with prenatally diagnosed congenital heart disease (CHD) have increased cesarean delivery (CD) rates, with no outcome improvement.

Objective

We aim to examine indications for delivery, indications for CD and risk factors associated with CD.

Study design

Retrospective cohort of 322 singleton pregnancies prenatally diagnosed with moderate to severe CHD. We compared maternal and fetal factors correlated with delivery route.

Results

CD rate was 46% (95% CI 40, 51%). Of all CD, 31.3% (95% CI 23.8, 38.7) were secondary to urgent fetal indications. However, 79.7% of inductions resulted in vaginal delivery (VD). Factors associated with CD include morbid obesity (RR 3.0, 95% CI 1.5, 6.1), diabetes (RR 3.9, 95% CI 2.0, 7.3) and severe pre-eclampsia (6.0, 95% CI 1.7, 21.4). Of the 10 most frequent CHD diagnoses, only hypoplastic-left-heart was associated with CD (OR 1.9, 95% CI 1.02, 3.4).

Conclusions

Although the CD rate is higher in fetal CHD, most indications for CD are maternal.

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Fig. 1: Flow-sheet of study participants by route of delivery.

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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Heather Masters & Sammy Tabbah

  2. Fetal Heart Program, Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Elisa Marcuccio, Alma Jukic, James Cnota & Allison Divanovic

Authors
  1. Heather Masters
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  2. Elisa Marcuccio
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  3. Alma Jukic
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  4. James Cnota
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  5. Sammy Tabbah
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  6. Allison Divanovic
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Contributions

HM, EM, JC, ST and AD conceived the idea. HM, EM, and AD developed the idea. HM and AJ collected the data and wrote the manuscript. All authors participated in review of results and contributed to discussion. HM, EM, JC, ST, and AD developed additional questions to answer.

Corresponding author

Correspondence to Heather Masters.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was performed in accordance with the Declaration of Helsinki. This study was approved by the institutional review board at Cincinnati Children’s Hospital Medical Center (IRB# 2019-0739) and University of Cincinnati Medical Center (IRB #2020-040).

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Masters, H., Marcuccio, E., Jukic, A. et al. Maternal and neonatal factors associated with cesarean delivery in a cohort of pregnancies complicated by prenatally diagnosed congenital heart disease. J Perinatol 44, 360–365 (2024). https://doi.org/10.1038/s41372-023-01747-9

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