Specialized delivery room planning for fetuses with critical congenital heart disease
- PMID: 23291087
- DOI: 10.1016/j.amjcard.2012.11.029
Specialized delivery room planning for fetuses with critical congenital heart disease
Abstract
Improvements in fetal echocardiography have increased recognition of fetuses with congenital heart disease (CHD) that require specialized delivery room (DR) care. In this study, care protocols for these low-volume and high-risk deliveries were created. Elements included (1) diagnosis-specific DR care plans and algorithms, (2) a multidisciplinary team with expertise, (3) simulation, (4) checklists, and (5) debriefing. The purpose of this study was to assess the accuracy of fetal echocardiography to predict the need for specialized DR care and determine the effectiveness of the care protocols for the treatment of patients with critical CHD. Fetal and postnatal medical records and echocardiograms of fetuses with CHD assigned to an advanced level of care were reviewed. Safety and outcome variables were analyzed to determine care plan and algorithm efficacy. Thirty-four fetuses were identified: 12 delivered at Children's National Medical Center and 22 at the adult hospital. Diagnoses included hypoplastic left heart syndrome, aortic stenosis, d-transposition of the great arteries, tetralogy of Fallot with absent pulmonary valve, complex pulmonary atresia, arrhythmias, ectopia cordis, and conjoined twins. Delivery at Children's National Medical Center was associated with a shorter time to specialty care or intervention. Measures of physiologic stability and survival were similar. Need for specialized care was predicted in 84% of deliveries. For hypoplastic left heart syndrome, intervention was predicted in 10 of 11 deliveries and for d-transposition of the great arteries in 10 of 12 deliveries. Care algorithms addressed most DR events. Of the unanticipated events, none were unrecoverable. DR survival was 100%, and survival to discharge was 83%. In conclusion, fetal echocardiography predicted the need for specialized DR care in fetuses with critical CHD. Algorithm-driven protocols enable planning such that maternal and infant risk is minimized and outcomes are good.
Copyright © 2013 Elsevier Inc. All rights reserved.
Similar articles
-
Predicting High-Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery.J Am Heart Assoc. 2024 Mar 19;13(6):e031184. doi: 10.1161/JAHA.123.031184. Epub 2024 Mar 18. J Am Heart Assoc. 2024. PMID: 38497437 Free PMC article. Review.
-
Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease.Echocardiography. 2017 Dec;34(12):1804-1821. doi: 10.1111/echo.13672. Echocardiography. 2017. PMID: 29287132 Review.
-
Fetal cardiology: changing the definition of critical heart disease in the newborn.J Perinatol. 2016 Aug;36(8):575-80. doi: 10.1038/jp.2016.20. Epub 2016 Mar 10. J Perinatol. 2016. PMID: 26963427 Review.
-
Risk-stratified postnatal care of newborns with congenital heart disease determined by fetal echocardiography.J Am Soc Echocardiogr. 2015 Nov;28(11):1339-49. doi: 10.1016/j.echo.2015.07.005. Epub 2015 Aug 20. J Am Soc Echocardiogr. 2015. PMID: 26298099
-
The evaluation of cardiac biometry in major cardiac defects detected in early pregnancy.Arch Gynecol Obstet. 2003 Jun;268(2):94-101. doi: 10.1007/s00404-002-0358-8. Epub 2002 Oct 29. Arch Gynecol Obstet. 2003. PMID: 12768297
Cited by
-
Untangling the Complex Associations between Socioeconomic and Demographic Characteristics and Prenatal Detection and Outcomes in Congenital Heart Disease.J Cardiovasc Dev Dis. 2024 May 18;11(5):155. doi: 10.3390/jcdd11050155. J Cardiovasc Dev Dis. 2024. PMID: 38786977 Free PMC article. Review.
-
Management of Ebstein Anomaly in the Current Era: The Story of One Fetus and the Collaboration of Many-A Case Report.J Cardiovasc Dev Dis. 2024 May 9;11(5):147. doi: 10.3390/jcdd11050147. J Cardiovasc Dev Dis. 2024. PMID: 38786969 Free PMC article.
-
Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning.J Cardiovasc Dev Dis. 2024 Mar 31;11(4):108. doi: 10.3390/jcdd11040108. J Cardiovasc Dev Dis. 2024. PMID: 38667726 Free PMC article. Review.
-
Initiating a Fetal Cardiac Program from Scratch in Low- and Middle-Income Countries: Structure, Challenges, and Hopes for Solutions.Pediatr Cardiol. 2024 Apr 19. doi: 10.1007/s00246-024-03479-9. Online ahead of print. Pediatr Cardiol. 2024. PMID: 38639814 Review.
-
Prenatal transposition of great arteries diagnosis and management: a Chinese single-center study.Front Cardiovasc Med. 2024 Mar 6;11:1341005. doi: 10.3389/fcvm.2024.1341005. eCollection 2024. Front Cardiovasc Med. 2024. PMID: 38510199 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical