Impact of prenatal diagnosis of transposition of the great arteries on obstetric and early postnatal management.
OBJECTIVE
A growing percentage of cases of transposition of the great arteries (TGA) are being diagnosed prenatally. A decrease in the percentage of spontaneous deliveries has been reported, but the rate of cesarean section (c-section) in this population has never been studied. Our goal was to determine whether prenatal diagnosis affects delivery and immediate neonatal management of TGA neonates.


METHODS
A series of 121 TGA arterial switch candidates were included over a 6-year period. Variables on delivery, clinical status at ICU admission, arrival time and atrial septostomy were recorded retrospectively. Comparisons between the two groups were made by Student's t or Chi-squared test.


RESULTS
A cohort of 121 patients was enrolled (48 prenatal and 73 postnatal diagnoses). Induced delivery and c-section were more frequent in the prenatal (54.1% and 31%) than in the postnatal diagnosis group (19.4% and 8%; p<0.0002 and p<0.001, respectively). The mean interval between birth and ICU admission was 2h 30 min in the prenatal compared to 26 h in the postnatal diagnosis group (p<0.001). Arrival times were similar in both groups. Atrial septostomy by umbilical route was more often feasible in the prenatal (81%) than in the postnatal diagnosis group (51%; p<0.001), with a higher rate of failure in the latter.


CONCLUSIONS
Prenatal awareness of TGA was associated with a higher percentage of induced deliveries and a major increase in the rate of c-section, without any impact on the newborn except easier umbilical atrial septostomy and earlier ICU admission.
Raboisson
M J
MJ
Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France. mjraboisson@aol.com
Samson
C
C
Ducreux
C
C
Rudigoz
R C
RC
Gaucherand
P
P
Bouvagnet
P
P
Bozio
A
A
D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007751:Labor, Induced; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*