title: Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease.
abstract: BACKGROUND
  Advances in cardiac surgery and congenital cardiology have led to an increasing number of women with congenital heart disease (CHD) reaching childbearing age. In general, cardiologists recommend vaginal delivery for women with CHD to avoid complications from Caesarean section as many women with CHD tolerate vaginal delivery well.
  
  
  RESULTS
  This is a single-center study comparing mode of delivery, pregnancy outcome, indications for Caesarean section and induction of labor between women with and without CHD. A historical cohort study was conducted including 116 patients with CHD. An individual threefold matching with 348 women without CHD was carried out. Caesarean section was performed in 46.6% of pregnancies with CHD (33.6% without CHD, P = 0.012). Primary Caesarean section increases with severity of CHD (P = 0.036), 33.3% of women with CHD had primary planned Caesarean section due to cardiac reasons. Induction of labor was performed in 45.7% of attempted vaginal deliveries in women with CHD (27.9% without CHD, P = 0.001). Lower mean birth weight (P = 0.004) and Small for Gestational Age (SGA) (P < 0.001) were more common in women with CHD. One CHD patient suffered from postpartum hemorrhage.
  
  
  CONCLUSIONS
  Concerns about maternal deterioration resulting in higher rates of induction of labor seem unjustified in most cases. Along with a possible reduction of Caesarean section on maternal request, a reduction of planned vaginal delivery may be expedient in reducing the rate of Caesarean section in women with CHD.
authors.affiliation: Women's Clinic (Frauenklinik), Klinikum Rechts der Isar, Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Joris
authors.initials: J
authors.lastname: Hrycyk
authors.affiliation: Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich (Deutsches Herzzentrum Muenchen), Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Kaemmerer
authors.affiliation: Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich (Deutsches Herzzentrum Muenchen), Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nagdyman
authors.affiliation: Women's Clinic (Frauenklinik), Klinikum Rechts der Isar, Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Hamann
authors.affiliation: Women's Clinic (Frauenklinik), Klinikum Rechts der Isar, Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Ktm
authors.initials: K
authors.lastname: Schneider
authors.affiliation: Women's Clinic (Frauenklinik), Klinikum Rechts der Isar, Technical University of Munich (Technische Universitaet Muenchen), Munich, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Kuschel
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome