Key result
A prenatal diagnosis of fetal congenital heart disease was associated with a significantly higher rate of operative vaginal delivery compared to non-anomalous pregnancies (18.09% vs 9.78%, OR 2.03).
Why the study?
The optimal mode of delivery in fetal congenital heart disease is not established, and few relevant studies have addressed operative vaginal delivery.
Does fetal congenital heart disease increase the risk of operative vaginal delivery or cesarean delivery in pregnant women?
Cohort (n=616)
No
Does fetal congenital heart disease increase the risk of operative vaginal delivery or cesarean delivery in pregnant women?
Odds Ratio: 2.03 (95% CI 1.13–3.63)
Absolute Event Rate: 18.09% vs 9.78%
p-value: p=0.01
Pregnancies complicated by fetal congenital heart disease are associated with a higher rate of operative vaginal delivery, primarily due to non-reassuring fetal heart rate, compared to non-anomalous pregnancies.
May warrant closer intrapartum monitoring in fetal CHD; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: The optimal mode of delivery in cases of fetal congenital heart disease (CHD) is not established. The few relevant studies did not address operative vaginal delivery. The aim of this study was to assess the impact of fetal CHD on mode of delivery during a trial of labor, and to secondarily describe some obstetric complications. METHODS: The database of a tertiary medical center was searched for women who gave birth to a singleton, liveborn neonate in 2015-2018. Mode of delivery was compared between women carrying a fetus with known CHD and women with a healthy fetus matched 1:5 for maternal age, parity, body mass index, and gestational age. RESULTS: The cohort included 616 women, 105 in the CHD group and 511 in the control group. The rate of operative vaginal delivery was significantly higher in the CHD group (18.09% vs 9.78%, OR 2.03, 95% CI 1.13-3.63, p = 0.01); the difference remained significant after adjustment for nulliparity and gestational age at delivery (aOR 2.58, 95% CI 1.36-4.9, p < 0.01). There was no difference between the CHD and control group in rate of intrapartum cesarean delivery (9.52% vs 10.76%, respectively, OR 0.97, 95% CI 0.47-1.98, p = 0.93). The most common indication for operative vaginal delivery was non-reassuring fetal heart rate (78.94% vs 64%, respectively). Median birth weight percentile was significantly lower in the CHD group (45th vs 53rd percentile, p = 0.04). CONCLUSIONS: Our findings suggest that operative vaginal delivery, performed mostly because of non-reassuring fetal heart rate, is more common in pregnancies complicated by a prenatal diagnosis of CHD than non-anomalous pregnancies.
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Zloto et al. (2022) conducted a cohort in Fetal congenital heart disease (n=616). Fetal congenital heart disease vs. Healthy fetus (non-anomalous pregnancy) was evaluated on Operative vaginal delivery (OR 2.03, 95% CI 1.13-3.63, p=0.01). A prenatal diagnosis of fetal congenital heart disease was associated with a significantly higher rate of operative vaginal delivery compared to non-anomalous pregnancies (18.09% vs 9.78%, OR 2.03).
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