Delivery Outcomes in Non-Tertiary Referral Centers for Women with Congenital Heart Disease

Background:Women with congenital heart disease(CHD)have increased risk for adverse events during pregnancy and delivery.Prior studies have assessed pregnancy and delivery outcomes at tertiary referral centers(TRC).The aim of our study was to assess pregnancy outcomes in women with CHD who deliver in a non-tertiary referral center(non-TRC).Methods:Clinical demographics were collected,including anatomic complexity,physiologic state and pre-pregnancy risk assessment.Patients were stratified by delivery location,either TRC or non-TRC.Maternal and neonatal complications of pregnancy were reported.Results:Women with CHD who delivered in a TRC had a higher pre-pregnancy risk when assessed by the Zahar and CARPREG-II scores,and had more patients fall into a higher WHO classification.There was no difference in rates of maternal cardiac complications between delivery locations(11%)and neonatal complications(20%)between deliveries at TRC and non-TRC.Conclusions:There were not increased maternal cardiac or neonatal complications when delivery occurred at a non-TRC.Neonatal complications remained high regardless of delivery location.This study suggests that proper risk assessment may help identify women who are candidates for safe delivery at non-TRC in women with CHD,and that neonatal resources should be considered when planning delivery location.