Presenter Status
Resident/Psychology Intern
Abstract Type
Research
Primary Mentor
Amanda McIntosh
Start Date
15-5-2025 12:30 PM
End Date
15-5-2025 12:45 PM
Presentation Type
Oral Presentation
Description
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.
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.
We analyzed 208 VD, 32 CD after a TOL, and 91 scheduled CD without a TOL patientsOn 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.
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.
Included in
Cardiology Commons, Higher Education and Teaching Commons, Medical Education Commons, Medical Physiology Commons, Pediatrics Commons
Duration of Labor and Umbilical Artery Acidosis in Critical Congenital Heart Disease
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.
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.
We analyzed 208 VD, 32 CD after a TOL, and 91 scheduled CD without a TOL patientsOn 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.
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.
