title: Foetal congenital heart disease: obstetric management and time to first cardiac intervention in babies delivered at a tertiary centre.
abstract: OBJECTIVE
  The aim of this study was to determine the timing of neonatal cardiac intervention in babies with antenatally diagnosed congenital heart disease and the impact on obstetric management.
  
  
  METHODS
  A retrospective review of all deliveries between January, 2008 and December, 2009 was conducted in a tertiary centre with foetal and paediatric cardiology, maternal-foetal medicine, and obstetric units. All live births with antenatally detected congenital heart disease were included. Data were collected from foetal, paediatric cardiology, and maternity databases and records. Induction, delivery mode, and timing of the first cardiac intervention in the neonate were studied.
  
  
  RESULTS
  205 deliveries were included. Induction and elective Caesarean section rates were 51.2% (105/205) and 14.1% (29/205), respectively. The vaginal delivery rate was 56% (115/205). There was a non-significant trend towards a higher rate of vaginal delivery after spontaneous labour than after induction (75% versus 66%; p = 0.234). The rate of neonatal cardiac intervention during the initial stay was 59.5% (122/205); it was 18.5% (38/205) within 48 hours and 25.8% (53/205) within 72 hours. The median time to first intervention was 4 days (interquartile range 2-8). Babies with hypoplastic left heart syndrome (median 3, interquartile range 2-6), transposition of the great arteries (median 1, interquartile range 0-4.5), and arrhythmia (median 0.5, interquartile range 0-1) had a significantly earlier time to first intervention compared with those with other conditions (p = 0.001).
  
  
  CONCLUSIONS
  Vaginal delivery can be achieved in women delivering babies with major congenital heart disease at a tertiary centre. Delivery in or near a tertiary centre is recommended for patients requiring early intervention, of which many can be identified in advance.
authors.affiliation: 1 Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom.
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Jowett
authors.affiliation: 2 Department of Fetal Medicine, Evelina Children's Hospital, London, United Kingdom.
authors.forename: Srividhya
authors.initials: S
authors.lastname: Sankaran
authors.affiliation: 1 Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom.
authors.forename: Sherrida L
authors.initials: SL
authors.lastname: Rollings
authors.affiliation: 3 Department of Cytogenetics, GSTS Pathology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Hall
authors.affiliation: 2 Department of Fetal Medicine, Evelina Children's Hospital, London, United Kingdom.
authors.forename: Pippa M
authors.initials: PM
authors.lastname: Kyle
authors.affiliation: 1 Department of Fetal cardiology, Evelina Children's Hospital, London, United Kingdom.
authors.forename: Gurleen K
authors.initials: GK
authors.lastname: Sharland
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D036861:Delivery, Obstetric; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors