Delivery outcomes of fetal single ventricle cardiac defects: Results of a multi-disciplinary approach

To review 9-year results of a single fetal care center protocol for obstetrical management and delivery of fetal single ventricle cardiac defects. We conducted a retrospective review of gravidas with a prenatal diagnosis of fetal hypoplastic right or left heart syndromes (HRHS or HLHS) co-managed by maternal fetal medicine, fetal cardiology and neonatology at a fetal care center. Subjects underwent fetal echocardiograms every 4 weeks and standard OB management with weekly antepartum testing after 32 weeks and planned induction of labor at 39 + weeks if the fetus was normally grown, and 38 weeks if growth restricted (< 10th%). Timing and mode of delivery were discussed at a multidisciplinary meeting. Pregnancies with aneuploidy were excluded and postnatal cardiac diagnoses were confirmed. Charts were reviewed for gestational age at delivery, and reasons for earlier or unplanned operative delivery. Data were compared between HRHS and HLHS. Two-sided Chi-square and Fisher’s exact tests were used for comparisons. Of 181 HLHS/HRHS presenting to the fetal care center, 155 diagnosed at 20-33 weeks were included (HLHS =112, HRHS =43) (Figure). For the entire cohort, most deliveries occurred at term (84.5%). Of 14.8% delivered preterm, rates were similar between HLHS and HRHS (Table). Preterm births were more often spontaneous than iatrogenic (65.2 vs 34.8%) and primarily due to preterm premature rupture of membranes in both groups. The overall cesarean delivery rate was 36.1%, but the unplanned cesarean delivery rate was only 13.5% overall. Unplanned cesarean occurred more often in HLHS than HRHS (17% vs 4.7%) and was more common for maternal than fetal indications (61.9% vs 38.1%). In our cohort of gravidas with fetal single ventricle syndromes, preterm birth is high compared to national averages, similar between HRHS and HLHS, and primarily due to spontaneous causes (not iatrogenic). A co-management and delivery protocol for HLHS/HRHS results in a cesarean delivery rate similar to the general population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)