Prenatal diagnosis of congenital heart disease: impact of mode of delivery on neonatal outcome.
OBJECTIVE
We sought to evaluate the impact of mode of delivery (MOD) on early outcome for neonates diagnosed prenatally with major forms of congenital heart disease (CHD).


METHODS
We retrospectively studied infants admitted, over a 2-year period, to a single institution for cardiac intervention. Infants were grouped on the basis of timing of diagnosis (prenatal/postnatal) and MOD--planned (induced labor or planned cesarean delivery) versus spontaneous labor. Multivariate logistic regression was used to evaluate independent predictors for MOD and early outcomes.


RESULTS
Of 329 patients, 45% received a prenatal diagnosis of CHD. A prenatal diagnosis of CHD increased the likelihood for planned delivery [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.6 to 4.5, p < 0.001]. Newborns prenatally diagnosed with CHD were more likely to have been delivered between 8 am and 6 pm, Monday through Friday (OR 2.3, 95% CI 1.1 to 4.8, p = 0.019). However, MOD had no statistical impact on Apgar score, duration of pre-operative intubation, and survival to surgery or to discharge. The Risk Adjustment for Congenital Heart Surgery 1 surgical mortality score was the only independent predictor of hospital mortality.


CONCLUSIONS
In our experience, although a prenatal diagnosis of CHD decreased the likelihood of spontaneous labor, MOD had no demonstrable impact on neonatal outcome.
Division of Pediatric Cardiology, Kaiser Permanente, Roseville, CA, USA. ltrento@gmail.com
Luca U
LU
Trento
Jay D
JD
Pruetz
Ruey K
RK
Chang
Jon
J
Detterich
Mark S
MS
Sklansky
D002140:California / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D012189:Retrospective Studies