Walsh C A, MacTiernan A, Farrell S, Mulcahy C, McMahon C J, Franklin O, Coleman D, Mahony R, Higgins S, Carroll S, McParland P, McAuliffe F M
Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
UCD Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
J Perinatol. 2014 Dec;34(12):901-5. doi: 10.1038/jp.2014.104. Epub 2014 May 29.
To determine the mode of delivery in pregnancies complicated by complex fetal congenital heart disease (CHD).
Five-year retrospective cohort study at a tertiary fetal medicine center (2007 to 2011). Cases of complex fetal CHD (n=126) were compared with 45 069 non-anomalous singleton infants ⩾500 g to determine rates of emergency intrapartum cesarean section (CS), preterm delivery and induction of labor.
Intrapartum CS is significantly higher in fetal CHD than non-anomalous controls (21% vs 13.5%, odds ratio (OR) 1.7, 95% confidence interval (CI): 1.0 to 2.7; P=0.035), predominantly related to CS for non-reassuring fetal status (OR 2.2, 95% CI: 1.1 to 4.1; P=0.022). Although fetal CHD did not increase emergency CS rates in nulliparous women, CS was significantly increased in multiparous pregnancies (OR 2.4, 95% CI: 1.8 to 4.6; P=0.014). Rates of preterm delivery (OR 3.4, 95% CI: 2.0 to 5.4; P<0.0001) and induction of labor (OR 1.9, 95% CI: 1.3 to 2.9; P=0.001) were higher in the CHD cases.
Emergency CS is increased in fetal CHD, attributed to a higher rate of CS for non-reassuring fetal status and seen mostly in multiparous women.
确定合并复杂胎儿先天性心脏病（CHD）的妊娠分娩方式。
在一家三级胎儿医学中心进行的为期五年的回顾性队列研究（2007年至2011年）。将复杂胎儿CHD病例（n = 126）与45069例体重≥500g的非畸形单胎婴儿进行比较，以确定紧急产时剖宫产（CS）、早产和引产率。
胎儿CHD组的产时CS显著高于非畸形对照组（21%对13.5%，优势比（OR）1.7，95%置信区间（CI）：1.0至2.7；P = 0.035），主要与因胎儿状况不佳而行的CS有关（OR 2.2，95%CI：1.1至4.1；P = 0.022）。虽然胎儿CHD并未增加初产妇的紧急CS率，但经产妇妊娠中的CS显著增加（OR 2.4，95%CI：1.8至4.6；P = 0.014）。CHD病例的早产率（OR 3.4，95%CI：2.0至5.4；P<0.0001）和引产率（OR 1.9，95%CI：1.3至2.9；P = 0.001）更高。
胎儿CHD的紧急CS增加，这归因于因胎儿状况不佳而行CS的比例更高，且主要见于经产妇。
