title: Management of Pregnancy and Survival of Infants with Trisomy 13 or Trisomy 18.
abstract: Objective The objective of this study was to describe antenatal/intrapartum management and survival of liveborn infants with known trisomy 13 (T13) or trisomy 18 (T18) based on planned neonatal care. Study Design This is a retrospective cohort study of singleton pregnancies complicated by T13/T18 at a tertiary center from 2004 to 2015. We included pregnancies with antenatal or neonatal cytogenetic T13/T18 diagnosis and excluded those which were terminated or had a fetal demise < 20 weeks. We compared antenatal/intrapartum management and neonatal survival by planned neonatal care, defined as either neonatal intervention (INT), including neonatal cardiopulmonary resuscitative measures or comfort care (CC) without resuscitative measures. Results In this study, 32 women (10 with T13 and 22 with T18) met study criteria; 12 (38%) elected INT and 20 (62%) CC. Compared with those who elected INT, women who elected CC were more likely to undergo elective induction (40 vs. 0%, p = 0.01), have an intrapartum stillbirth (0 vs. 32%, p = 0.14), and deliver vaginally (25 vs. 63%, p < 0.01). In neonatal survival analysis (n = 26), median survival was longer in the INT group compared with CC group (64 days [interquartile range, IQR: 2, 155) vs. 3 days [IQR]: 0.3, 42), p = 0.28), but survival to hospital discharge was similar (53 vs. 57%, p = 0.95). Conclusion Regardless of desired level of neonatal INT, many women who continue pregnancies complicated by T13/18 have infants who survive beyond hospital discharge.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dotters-Katz
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Carlson
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Patterson
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Grace
authors.affiliation: Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Wayne
authors.initials: W
authors.lastname: Price
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Vladutiu
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Manuck
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Strauss
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D000070659:Patient Comfort; D057240:Patient Preference; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D050497:Stillbirth; D015996:Survival Rate; D000073839:Trisomy 13 Syndrome / Q000175:diagnosis*; D000073842:Trisomy 18 Syndrome / Q000175:diagnosis*