Fetus
Poster Session 3
Shelly Soni, MD
Assistant Professor
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Juliana S. Gebb, MD (she/her/hers)
Associate Professor
Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia
Philadelphia, PA, United States
Nahla Khalek, MD,MPH,MMedEd
Assistant Professor
Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia
Philadelphia, PA, United States
Christina (Nina) Paidas Teefey, MD, PMH-C
Assistant Professor, Clinical Obstetrics and Gynecology in Surgery
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Serena Wu, MD
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Kayla Neary, BA
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Kathleen Gianforcaro, BA
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Lisa Pilchman, MS
Licensed Genetic Counselor II
Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia
Philadelphia, PA, United States
Jack Rychik, MD
Medical Director, Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, PA, United States
Julie Moldenhauer, MD
Professor, Director of Obstetrical Services in the Center for Fetal Diagnosis and Treatment
Richard D. Wood, Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania
Philadelphia, PA, United States
To evaluate perinatal outcomes in singleton fetal congenital heart disease (CHD) cases with and without fetal growth restriction (FGR).
Study Design:
Single center retrospective analysis of singleton pregnancies with diagnosis of fetal CHD delivering at ≥ 37 weeks between July 1, 2020 and July 31, 2022. Cardiac anomalies were stratified by the neonatal level of care plan and graded from 1-4 in increasing order of complexity. The primary outcomes were birth-surgery interval and survival to hospital discharge. The FGR group was compared to the appropriately grown (AGA) group.
Results:
389 pregnancies delivered during the study period. Of these, 61 (15.7%) were FGR and 328 (84.3%) were AGA. Pregnancies with FGR delivered at an earlier gestational age (p< 0.0001). Induction of labor rates were higher in the FGR group (69% vs 51%). Mode of delivery and NICU length of stay were comparable in both groups. On univariate analysis, birth-surgery interval was significantly greater (p=0.02), and neonatal survival rate was lower in the FGR group (p=0.03). On multiple regression (Table 2), the diagnosis of FGR did not influence birth-surgery interval (p=0.29) which was driven by the complexity of cardiac anomaly (p< 0.0001). However, FGR diagnosis along with the complexity of cardiac anomaly had a significant impact on the survival rate on logistic regression (p=0.03 and 0.007) (Table 3). Upon stratification of the FGR pregnancies by gestational age at delivery, 10 pregnancies delivered beyond 39 weeks and were not included due to small sample size. Outcomes were compared for gestational age at delivery between 37-37.6 weeks and 38-38.6 weeks. Gestational age at delivery influenced birth-surgery interval (p=0.008) and survival rate (p=0.04) in the FGR group on regression analysis.
Conclusion:
In singleton term pregnancies with fetal CHD, FGR was associated with a lower neonatal survival rate. In the FGR group, early gestational age at delivery had greater birth-surgery interval and lower neonatal survival rates.