Timing of Delivery in Women with Cardiac Disease

Caroline E. Rouse; Sarah Rae Easter; Valeria E. Duarte; Sheila Drakely; Fred M. Wu; Anne Marie Valente; Katherine E. Economy

doi:10.1055/s-0040-1721716

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 39(11): 1196-1203
DOI: 10.1055/s-0040-1721716

Original Article

Timing of Delivery in Women with Cardiac Disease

Caroline E. Rouse

¹Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts

,

Sarah Rae Easter

¹Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts

,

Valeria E. Duarte

²Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts

³Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Sheila Drakely

²Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts

³Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Fred M. Wu

²Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts

³Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Anne Marie Valente

²Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts

³Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Katherine E. Economy

¹Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts

› Author Affiliations

Abstract

Objective Guidelines do not exist to determine timing of delivery for women with cardiovascular disease (CVD) in pregnancy. The neonatal benefit of a term delivery as compared with an early term delivery is well described. We sought to examine maternal outcomes in women with CVD who delivered in the early term period (37^0/7 through 38^6/7 weeks) compared with those who delivered later.

Study Design This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal, and obstetric characteristics were evaluated.

Results Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of any hypertension during pregnancy (18.1 vs. 7%, p = 0.01) and intrauterine growth restriction (22.9 vs. 2.8%, p < 0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8 vs. 3.5%, p = 0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4 vs. 24.7%, p = 0.004).

Conclusion There is no maternal benefit of an early term delivery in otherwise healthy women with CVD. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women.

Key Points

Question of delivery timing in women with cardiac disease.
No difference in cardiac morbidity, term versus early term.
Term delivery in women with asymptomatic cardiac disease.

Keywords

cardiac disease in pregnancy - early term delivery - timing of delivery - congenital heart disease

Full Text

References

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