Multi-Institutional Practice-Patterns in Fetal Congenital Heart…

Research question

Can a standardized clinical assessment and management plan (SCAMP) reduce early-term delivery and cesarean delivery in fetal congenital heart disease?

Clinical & scientific significance

Clinical pathways can standardize care, reduce maternal risk from cesarean delivery and may improve neonatal outcomes and costs.

Key findings reported in the paper

Gestational age at delivery increased (38.9 vs 38.1 weeks, p = 0.01).
Vaginal deliveries rose to 61% vs 50% in historical controls (p = 0.03); among major cardiac lesions, from 51% to 64%, and deliveries at ≥ 39 weeks from 33% to 48%.

Vaginal birth, major cardiac lesions

Vaginal birth, major cardiac lesions
After care plan	64% (64%)
Historical cohort	51% (51%)

p = 0.008 (n = 373 pregnancies with major lesions). Values as reported in the abstract. Data as reported in the publication abstract.

Objectives

To compare delivery practices before and after implementing a SCAMP in the University of California Fetal-Maternal Consortium.

Methods

496 maternal-fetal dyads with prenatally diagnosed congenital heart disease: 185 historical controls vs 311 after implementation.

This summary is based only on the published abstract.

Standardizing delivery planning in fetal heart disease

01
Prenatal diagnosis
Congenital heart disease identified before birth.
02
Shared care plan
A standardized assessment and management plan guides decisions across sites.
03
Timing of delivery
Later delivery recommended; average gestational age rose from 38.1 to 38.9 weeks.
04
Mode of delivery
Vaginal birth was recommended in 77% of the cohort and became more frequent.

Quality-improvement approach reported in J Am Heart Assoc 2021 across University of California centers. Conceptual illustration — not experimental data.

Read the publication

Free full text (PMC): PMC8475692 (opens in a new tab)

Neonatal & developmental cardiologyMaternal-fetal medicine

Authors

Afshar Y, Hogan WJ, Conturie C, Sunderji S, Duffy JY, Peyvandi S, Boe NM, Melber D, Fajardo VM, Tandel MD, Holliman K, Kwan L, Satou G, Moon-Grady AJ

Citation

Multi-Institutional Practice-Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan. J Am Heart Assoc. 2021; 10(15):e021598. doi:10.1161/JAHA.121.021598. PMID: 34315235.

Multi-Institutional Practice-Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan