Title: EP09.08: Mode of delivery in fetuses with congenital heart disease: a systematic review of the literature
Abstract: To review literature about mode of delivery in fetuses affected with congenital heart disease (CHD). Search in PubMed, EMBASE, clinicaltrials.org and reference list limited from January 2000 to February 2019. Key words were: congenital heart disease, vaginal delivery, Caesarean section, planned Caesarean section, neonatal mortality. From each article, the following data were analysed: mode of delivery, gestational age at delivery, and indication for emergency Caesarean section. PRISMA guidelines were followed. From 9 articles, 5217 fetuses were with CHD pooled. Aneuploidies were present in 12.1% of cases and extracardiac anomalies were detected in 15.2% of cases. Prematurity complicated 27.5% of pregnancies. Induction of labour was performed in 31.3% of term pregnancies. Mode of delivery was vaginal delivery in 2901/5217 (55.6%) cases and Caesarean section in 2316/5217 (44.4%) cases. In all but one study, i.e. 1866 fetuses affected with CHD, Caesarean section was classified as planned or emergency Caesarean. The former occurred in 971 (52.0%) of cases, whereas emergency Caesarean section was necessary in 895 (48.0%) fetuses. Non-reassuring fetal heart rate represented the main indication for emergency Caesarean section in 66.0% of Caesarean section performed during labour. Mode of delivery was not stratified according to the type of CHD and there was no comparison between neonatal outcomes following vaginal delivery and planned Caesarean section. Neonatal death occurred in 500/5217 (9.5%) of fetuses with CHD. In fetuses with CHD, vaginal delivery is successful in approximately half of cases. However, abnormal heart rate might occur in about 66% of cases, for which emergency Caesarean section is necessary. Limitations of literature include mode of delivery not stratified for type of CHD, prenatal and postnatal diagnosis of CHD not compared with regard to mode of delivery, neonatal morbidity not compared between planned Caesarean section and vaginal delivery, how extracardiac anomalies impact on mode of delivery.