Timing and Indications for Delivery at Less Than 39 Weeks in Neonates With Complex Congenital Heart Disease [28O]

INTRODUCTION: To describe timing and indications for delivery at less than 39 weeks of gestation in neonates with complex congenital heart disease (CCHD)., METHODS: All neonates with CCHD admitted to Loma Linda University Children's Hospital from 2011 to 2015 were included in this study. Review of medical records was performed to collect data regarding CCHD lesion, maternal medical or fetal conditions and indication for delivery at less than 39 weeks of gestation. Indications for delivery were summarized by categories based on gestational age. Descriptive statistics were used to compare the groups., RESULTS: There were a total of 330 neonates admitted with CCHD during the study period with 129/330 (39%) born at less than 39 weeks GA with spontaneous labor in 54/129 (42%). The majority, 81/129 (63%) were born at early term, 34/129 (26%) were late preterm births and 14/129 (11%) were born prior to 34 weeks of gestation. Pregestational and gestational diabetes complicated 34/129 (26%) of the pregnancies while hypertensive disorders of pregnancy and intrauterine growth retardation were present in 18/129 (14%) and 13/129 (10%) of pregnancies, respectively. Vaginal and cesarean section deliveries accounted for 53% and 47% of the cases, respectively. Repeat cesarean sections with and without labor (38%), non-reassuring fetal heart rate patterns (21%) and breech presentation (20%) were the main indications for cesarean delivery., CONCLUSION: Delivery at less than 39 weeks of gestation is common in neonates with CCHD and more likely reflective of preterm labor, maternal medical or fetal condition rather than elective delivery., (C) 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.