title: Mode of delivery in pregnancies complicated by major fetal congenital heart disease: a retrospective cohort study.
abstract: OBJECTIVE
  To determine the mode of delivery in pregnancies complicated by complex fetal congenital heart disease (CHD).
  
  
  METHODS
  Five-year retrospective cohort study at a tertiary fetal medicine center (2007 to 2011). Cases of complex fetal CHD (n=126) were compared with 45 069 non-anomalous singleton infants ⩾500 g to determine rates of emergency intrapartum cesarean section (CS), preterm delivery and induction of labor.
  
  
  RESULTS
  Intrapartum CS is significantly higher in fetal CHD than non-anomalous controls (21% vs 13.5%, odds ratio (OR) 1.7, 95% confidence interval (CI): 1.0 to 2.7; P=0.035), predominantly related to CS for non-reassuring fetal status (OR 2.2, 95% CI: 1.1 to 4.1; P=0.022). Although fetal CHD did not increase emergency CS rates in nulliparous women, CS was significantly increased in multiparous pregnancies (OR 2.4, 95% CI: 1.8 to 4.6; P=0.014). Rates of preterm delivery (OR 3.4, 95% CI: 2.0 to 5.4; P<0.0001) and induction of labor (OR 1.9, 95% CI: 1.3 to 2.9; P=0.001) were higher in the CHD cases.
  
  
  CONCLUSIONS
  Emergency CS is increased in fetal CHD, attributed to a higher rate of CS for non-reassuring fetal status and seen mostly in multiparous women.
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: C A
authors.initials: CA
authors.lastname: Walsh
authors.affiliation: UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: MacTiernan
authors.affiliation: UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Farrell
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Department of Pediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
authors.forename: C J
authors.initials: CJ
authors.lastname: McMahon
authors.affiliation: Department of Pediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
authors.forename: O
authors.initials: O
authors.lastname: Franklin
authors.affiliation: Department of Pediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Coleman
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Mahony
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Higgins
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: McParland
authors.affiliation: 1] Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland [2] UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: F M
authors.initials: FM
authors.lastname: McAuliffe
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005315:Fetal Diseases; D006330:Heart Defects, Congenital; D006343:Heart Septal Defects; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies