Key result
Later delivery timing linked to ~70% more unplanned cesarean deliveries despite fewer preterm births.
Why the study?
Practice shifted toward delivering infants at later gestational ages after 2009 data showed improved outcomes among early- vs late-term infants, but effects on neonates with congenital heart disease were unclear.
Does a shift toward later gestational age delivery improve neonatal morbidity and mortality in neonates with significant congenital heart disease?
Cohort (n=1,002)
No
Does a shift toward later gestational age delivery improve neonatal morbidity and mortality in neonates with significant congenital heart disease?
Delaying delivery to later gestational ages in neonates with significant congenital heart disease increases birth weight but does not improve neonatal mortality or length of stay, while potentially increasing the risk of urgent maternal deliveries.
Answers are grounded in this paper and cite their sources.
Caution advised before shifting delivery timing in congenital heart disease; leaves open net effects on morbidity and warrants prospective trials.
OBJECTIVE: Because of data published in 2009 demonstrating improved outcomes among early- vs. late-term infants,practice shifted toward delivering infants at later gestational ages. We examined the effects of this change on neonates with congenital heart disease. DESIGN: This was a retrospective cohort study. Neonates with congenital heart disease born between 2004 and 2008 were compared with those born in 2010. Patients born in 2009, considered to be a transitional year, were excluded. SETTING: Our study was conducted at a tertiary care level 4 neonatal intensive care unit with comprehensive cardiac service. PATIENTS: Study subjects consisted of neonates with significant congenital heart disease admitted between 2004 and 2010. OUTCOME MEASURES: Outcomes measures consisted of mode of delivery, length of stay, neonatal morbidity, and mortality. RESULTS: There were 878 infants with congenital heart disease born in 2004-2008 and 124 in 2010. The mean gestational age was higher in 2010 than in 2004-2008 (38.4 ± 1.9 vs. 37.8 ± 2.3 weeks, P = .001), and there were fewer preterm births in 2010 compared with 2004-2008 (P = .003, odds ratio [OR] = 0.4). Mean birth weight was also higher in 2010 (3134 ± 675 vs. 2975 ± 599 g, P = .008). In 2010, less than half as many infants were born via scheduled induction (P < .001, OR = 0.2) or scheduled cesarean delivery (P = .002, OR = 0.4) as in 2004-2008. However, in 2010, there were more urgent inductions (P = .002, OR = 3.1), cesarean deliveries after labor (P = .01, OR = 2.2),and unplanned cesarean deliveries in general (P = .02, OR = 1.7) compared with 2004-2008. In 2010, neonates were less likely to require preoperative vasopressors (P = .002), but there were no differences in 5 minutes APGAR,antibiotic administration, preoperative intubation, median length of stay, or mortality compared with 2004-2008.Conclusions. Despite increased gestational age and birth weight following the shift in delivery practice, there was no difference in length of stay, neonatal morbidity, or mortality in infants with congenital heart disease. The resultant increase in urgent cesarean delivery and urgent inductions may confer additional maternal morbidity.
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Dadlez et al. (2014) conducted a cohort in significant congenital heart disease (n=1,002). Shift in delivery practice toward later gestational ages (birth in 2010) vs. Birth in 2004-2008 was evaluated on unplanned cesarean deliveries in general (OR 1.7, p=0.02). A shift in delivery practice toward later gestational ages was associated with fewer preterm births but more unplanned cesarean deliveries, with no difference in neonatal mortality.
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