title: Prevalence and descriptive analysis of congenital heart disease in parturients: obstetric, neonatal, and anesthetic outcomes.
abstract: OBJECTIVE
  The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD.
  
  
  METHODS
  This was a retrospective cohort study of women who delivered at the University of Colorado Hospital. Diagnosis of CHD was identified based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis prophylaxis during labor and confirmed with echocardiogram when available. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was performed.
  
  
  METHODS
  University of Colorado Hospital.
  
  
  METHODS
  18,226 women.
  
  
  METHODS
  Medical record review.
  
  
  METHODS
  Valvular abnormalities, New York Heart Failure Association classification scores, types of CHD, maternal age, race, gravidity, parity, maternal prepregnancy body mass index, cigarette use, type of delivery, type of analgesia used, early initiation of neuraxial analgesia, arrhythmias, need for peripartum diuretics, prolonged maternal hospital stay, preterm birth, small for gestational age, neonatal CHD, neonatal or maternal intensive care unit (ICU) admissions, and maternal or neonatal death.
  
  
  RESULTS
  We identified 117 pregnancies in 110 women with CHD. Parturients with CHD were more likely to have operative vaginal delivery (P < .0001), neonatal ICU admissions (P = .003), and had prolonged hospital stays. Occurrence of CHD in neonates was 6%. Moderate-to-severe valvular disease was associated with increased rates of operative vaginal delivery, early initiation of neuraxial labor analgesia, cardiac complications (including arrhythmia and use of diuretics), prolonged hospital stay, and maternal ICU admission. However, most deliveries and births were uncomplicated; and there were one case each of maternal mortality and fetal death after birth.
  
  
  CONCLUSIONS
  Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are generally well tolerated with low mortality rates.
authors.affiliation: Department of Anesthesiology, University of Colorado, 12401 E 17th Ave 7th Floor, Aurora, CO, 80045; Department of Anesthesiology, University of Utah, 30 North 1900 East, 3C-444 SOM, Salt Lake City, UT, 84132. Electronic address: christine.warrick@hsc.utah.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Warrick
authors.affiliation: Department of Obstetrics Gynecology, University of Colorado, School of Medicine, Academic Office 1, Room 4010, 12631 E 17th Ave, Mailstop B198-1, Aurora, CO, 80045.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Hart
authors.affiliation: Department of Obstetrics Gynecology, University of Colorado, School of Medicine, Academic Office 1, Room 4010, 12631 E 17th Ave, Mailstop B198-1, Aurora, CO, 80045. Electronic address: Anne.Lynch@ucdenver.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Lynch
authors.affiliation: Department of Anesthesiology, University of Colorado, 12401 E 17th Ave 7th Floor, Aurora, CO, 80045. Electronic address: Joy.Hawkins@ucdenver.edu.
authors.forename: Joy A
authors.initials: JA
authors.lastname: Hawkins
authors.affiliation: Department of Anesthesiology, University of Colorado, 12401 E 17th Ave 7th Floor, Aurora, CO, 80045. Electronic address: Brenda.Bucklin@ucdenver.edu.
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Bucklin
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D000773:Anesthesia, Obstetrical / Q000379:methods*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007902:Length of Stay; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anesthesia; Congenital heart disease; Neonates; Obstetric; Outcome; Pregnancy