title: Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies.
abstract: OBJECTIVE
  To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD).
  
  
  METHODS
  A systematic review and meta-analysis were performed following an electronic search of PubMed and Scopus databases (last searched August 2015). Perinatal outcomes that were assessed included fetal death, live birth, preterm delivery < 37 weeks' gestation and neonatal death. Intrauterine complications that were assessed included bradycardia requiring treatment and hemopericardium requiring drainage. Estimated proportions were reported as mean (95% CI). Inconsistency was assessed using the I2statistic.
  
  
  RESULTS
  An electronic search identified 2279 records, of which 29 studies (11 retrospective cohort and 18 case reports) were considered eligible for analysis. Fetal death after treatment of CHD by aortic valvuloplasty was reported in three studies, with a rate of 31% (95% CI, 9-60%), after pulmonary valvuloplasty in one study, with a rate of 25% (95% CI, 10-49%), after septoplasty in one study, with a rate of 14% (95% CI, 6-28%) and after pericardiocentesis and/or pericardioamniotic shunt placement in 24 studies, with a rate of 29% (95% CI, 18-41%). Bradycardia requiring treatment was reported after aortic valvuloplasty in two studies, with a rate of 52% (95% CI, 16-87%), after pulmonary valvuloplasty in one study, with a rate of 44% (95% CI, 23-67%), and after septoplasty in one study, with a rate of 27% (95% CI, 15-43%).
  
  
  CONCLUSIONS
  Current evidence on the effectiveness of prenatal intervention for CHD derives mostly from case reports and a few larger series; no study was randomized. Although the results of the meta-analysis are encouraging in terms of perinatal survival, they should be interpreted with caution when comparing with procedures performed after delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil. araujojred@terra.com.br.
authors.forename: E
authors.initials: E
authors.lastname: Araujo Júnior
authors.affiliation: Department of Obstetrics and Gynecology, Prenatal Diagnostic Center, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tonni
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chung
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine - São Paulo University (FMRP-USP), Ribeirão Preto, Brazil.
authors.forename: W P
authors.initials: WP
authors.lastname: Martins
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D064887:Observational Studies as Topic; D018743:Perinatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*
keywords: fetal cardiac intervention; intrauterine complications; pericardiocentesis; perinatal outcomes; septoplasty; valvuloplasty