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Intrapartum course of fetuses with isolated hypoplastic left heart syndrome
G M Jackson1, J Ludmir, A J Castelbaum
1Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia.
Insights
Hypoplastic left heart syndrome (HLHS) is now surgically treatable. Review of 13 HLHS cases shows labor and vaginal delivery are safe, with good neonatal outcomes, supporting routine intrapartum monitoring.
Area of Science:
- Cardiology
- Neonatal Medicine
- Obstetrics
Background:
- Hypoplastic left heart syndrome (HLHS) was historically fatal.
- Advances in surgical treatment allow for newborn intervention.
- Management strategies for labor and delivery require clarification.
Purpose of the Study:
- To review the intrapartum course and neonatal outcomes of fetuses with HLHS.
- To inform management plans for labor and delivery in HLHS pregnancies.
Main Methods:
- Retrospective review of 13 fetuses diagnosed with HLHS.
- Analysis of intrapartum monitoring data and immediate neonatal outcomes.
Main Results:
- 11 of 13 patients underwent labor without significant fetal distress.
- No meconium staining was observed.
- All infants had Apgar scores ≥8 and umbilical cord pH ≥7.20.
- All infants survived for initial reconstructive surgery.
Conclusions:
- Labor appears to be a low-risk situation for fetuses with HLHS.
- Routine intrapartum fetal monitoring and oxytocin use are appropriate.
- Cesarean delivery should be reserved for standard obstetric indications.
Abstract:
Once considered universally fatal, the hypoplastic left heart syndrome is now being surgically treated in the newborn period. To help formulate an appropriate management plan for the labor and delivery of these patients, we reviewed the intrapartum course and immediate neonatal outcome of 13 fetuses with known hypoplastic left heart syndrome. Eleven of 13 patients underwent labor, and only one had an abnormal fetal heart pattern. There were no cases with meconium staining of the amniotic fluid. All patients with spontaneous or induced labor were delivered vaginally. There were no Apgar scores less than 8 at 5 minutes, and all umbilical cord blood pH values were greater than or equal to 7.20. All infants survived to undergo initial reconstructive surgery. We conclude that labor does not appear to be a high-risk situation for the fetus with this disorder. Routine intrapartum fetal heart rate monitoring can be used, oxytocin can be used as indicated, and cesarean section should be reserved for traditional obstetric indications.