Publication Date

2-2025

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Abstract

• Background (83 words): Standard delivery protocols for most prenatally diagnosed CCHD is induction of labor at 39 weeks with aims of a vaginal delivery (VD) near a tertiary care center. There is no benefit to planned Cesarean delivery (CD) over VD for most infants with CCHD. However, longer durations of labor (DOL) in CCHD have been described as a risk factor for umbilical artery (UA) acidosis. We aim to describe the relationship between DOL and UA pH and neonatal outcomes in those with prenatally diagnosed CCHD. • Methods (150 words): Retrospective chart review of prenatally diagnosed with CCHD born at Children’s Mercy from 2012 – 2023. Inclusion criteria was CCHD defined as anticipated neonatal intervention or prostaglandin dependence, single ventricle (SV) circulation, or risk of hemodynamic instability with placental separation. Excluded fetal demise, multiple gestations, prematurity, post-maturity, and comfort cares. Divided subjects into 3 groups: those who had VD, CD after a trial of labor (TOL), or CD without a TOL. The primary outcome was UA pH. Secondary outcomes were delivery room intubation, perinatal brain injury, and peak lactate, cardiac arrest, death, or inotropic support in the first 24 hours of life. Collected demographic and clinical information for the maternal-fetal dyad. Divided CCHD diagnoses into 4 groups based on SV versus biventricular anatomy and the presence of systemic outflow obstruction. Welch 2-sample test or ANOVA were used for inter-group comparisons. For associations, multivariable linear regression modeling was performed. • Results: (150 words) Analyzed 201 VD, 32 CD after a TOL, and 90 scheduled CD without a TOL patients. Between the groups, there was no difference in birth weight (BW), gestational age (GA), intrauterine growth restriction (IUGR), and UA pH. Mothers with planned CD were older and delivered fetuses with higher rates of genetic syndromes. On univariate analysis, DOL in VD group was associated with lower UA pH (estimate -0.0006707 (95% CI: [-0.00130, -0.00005], P-value: 0.037). This remained significant on multivariable analysis controlling for GA, BW, hydrops, genetic syndromes, and IUGR (P-value = 0.011). Looking at CCHD subgroups, DOL and UA pH only had a significant association in neonates with SV anatomy and systemic obstruction (P-value= 0.009). DOL and lactate had a significant relationship on univariate (estimate 0.01479 (95% CI: [0.00307,0.02651], P-value= 0.014) and multivariate analysis (p-value = 0.015). There was not a significant relationship between DOL and other secondary outcomes. • Conclusion (51 words) In this single center retrospective study of fetuses with CCHD, longer duration of labor was associated with higher neonatal lactate levels. It was associated with lower UA pH in neonates with single ventricle anatomy and systemic obstruction. This may be a modifiable risk factor in certain subsets of prenatally diagnosed CCHD.

Disciplines

Cardiology | Pediatrics

Notes

Presented at Cardiology 2025: 28th Annual Update on Pediatric and Congenital Cardiovascular Disease; Orlando, FL; February 19-23, 2025.

Duration of Labor and Umbilical Artery Acidosis in Critical Congenital Heart Disease

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