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

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.