title: Intrauterine fetal demise after prenatal diagnosis of congenital heart disease: assessment of risk.
abstract: OBJECTIVE
  Elective deliveries in fetal congenital heart disease (CHD) attempt to balance fetal and neonatal risk with the goal of optimizing overall outcome. However, the magnitude of the risk for intrauterine fetal demise (IUFD) is unclear. This study aimed to (1) determine the rate of IUFD and (2) identify fetal risk factors associated with IUFD.
  
  
  METHODS
  Retrospective review of pregnancies complicated by CHD between 1998 and 2010. Data were collected regarding pregnancy outcome, extracardiac anomalies (ECA), genetic and cardiac diagnoses, severity of valve regurgitation, gestational age at birth and birth weight. Fisher's exact test and odds ratios were used to compare outcomes between groups.
  
  
  RESULTS
  A total of 501 pregnancies analyzed resulted in 445 live births, 22 IUFD, 16 terminations and 18 unknown outcomes. Amongst IUFD, 27% had a genetic diagnosis, 50% had an ECA and 27% had severe valve regurgitation. IUFD odds increased threefold with ECA and sevenfold with severe valve regurgitation. IUFD occurred in 1.2% without risk factors.
  
  
  CONCLUSIONS
  IUFD in fetuses with CHD is associated with ECA, genetic syndromes and severe valve regurgitation. In absence of these fetal characteristics, the occurrence of IUFD is low, although it remains higher than in fetuses without CHD.
authors.affiliation: Fetal Heart Program, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Divanovic
authors.affiliation: Fetal Heart Program, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Bowers
authors.affiliation: Fetal Heart Program, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Michelfelder
authors.affiliation: University Hospital Center for Women's Health, Division of Maternal Fetal Medicine, University Hospital, Cincinnati, OH, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Jaekle
authors.affiliation: University Hospital Center for Women's Health, Division of Maternal Fetal Medicine, University Hospital, Cincinnati, OH, USA.
authors.forename: Tondra
authors.initials: T
authors.lastname: Newman
authors.affiliation: TriHealth Department of OB/GYN, Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Marcotte
authors.affiliation: TriHealth Department of OB/GYN, Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA.
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.affiliation: Fetal Heart Program, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Cnota
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000453:epidemiology; D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D030342:Genetic Diseases, Inborn / Q000453:epidemiology; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal; D055815:Young Adult