Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan
Background Prenatal diagnosis of congenital heart disease has been associated with early‐term delivery and cesarean delivery (CD). We implemented a multi‐institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal‐Maternal Consortium. Our obj...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-08-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021598 |
| _version_ | 1811245221962317824 |
|---|---|
| author | Yalda Afshar Whitnee J. Hogan Charlotte Conturie Sherzana Sunderji Jennifer Y. Duffy Shabnam Peyvandi Nina M. Boe Dora Melber Viviana M. Fajardo Megha D. Tandel Kerry Holliman Lorna Kwan Gary Satou Anita J. Moon‐Grady |
| author_facet | Yalda Afshar Whitnee J. Hogan Charlotte Conturie Sherzana Sunderji Jennifer Y. Duffy Shabnam Peyvandi Nina M. Boe Dora Melber Viviana M. Fajardo Megha D. Tandel Kerry Holliman Lorna Kwan Gary Satou Anita J. Moon‐Grady |
| author_sort | Yalda Afshar |
| collection | DOAJ |
| description | Background Prenatal diagnosis of congenital heart disease has been associated with early‐term delivery and cesarean delivery (CD). We implemented a multi‐institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal‐Maternal Consortium. Our objective was to decrease early‐term (37–39 weeks) delivery and CD in pregnancies complicated by fetal congenital heart disease using a SCAMP methodology to improve practice in a high‐risk and clinically complex setting. Methods and Results University of California Fetal‐Maternal Consortium site‐specific management decisions were queried following SCAMP implementation. This contemporary intervention group was compared with a University of California Fetal‐Maternal Consortium historical cohort. Primary outcomes were early‐term delivery and CD. A total of 496 maternal–fetal dyads with prenatally diagnosed congenital heart disease were identified, 185 and 311 in the historical and intervention cohorts, respectively. Recommendation for later delivery resulted in a later gestational age at delivery (38.9 versus 38.1 weeks, P=0.01). After adjusting for maternal age and site, historical controls were more likely to have a CD (odds ratio [OR],1.8; 95% CI, 2.1–2.8; P=0.004) and more likely (OR, 2.1; 95% CI, 1.4–3.3) to have an early‐term delivery than the intervention group. Vaginal delivery was recommended in 77% of the cohort, resulting in 61% vaginal deliveries versus 50% in the control cohort (P=0.03). Among pregnancies with major cardiac lesions (n=373), vaginal birth increased from 51% to 64% (P=0.008) and deliveries ≥39 weeks increased from 33% to 48% (P=0.004). Conclusions Implementation of a SCAMP decreased the rate of early‐term deliveries and CD for prenatal congenital heart disease. Development of clinical pathways may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce healthcare costs. |
| first_indexed | 2024-04-12T14:36:39Z |
| format | Article |
| id | doaj.art-eb9db01582a042bba562d2e489c01560 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T14:36:39Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-eb9db01582a042bba562d2e489c015602022-12-22T03:29:05ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-08-01101510.1161/JAHA.121.021598Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management PlanYalda Afshar0Whitnee J. Hogan1Charlotte Conturie2Sherzana Sunderji3Jennifer Y. Duffy4Shabnam Peyvandi5Nina M. Boe6Dora Melber7Viviana M. Fajardo8Megha D. Tandel9Kerry Holliman10Lorna Kwan11Gary Satou12Anita J. Moon‐Grady13Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Los Angeles CADivision of Pediatric Cardiology Department of Pediatrics University of California San Francisco CADivision of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California San Diego CADivision of Pediatric Cardiology Department of Pediatrics University of California Davis CADivision of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Irvine CADivision of Pediatric Cardiology Department of Pediatrics University of California San Francisco CADivision of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Davis CADepartment of Urology University of California Los Angeles CADivision of Neonatology Department of Pediatrics University of California Los Angeles CADepartment of Urology University of California Los Angeles CADivision of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Los Angeles CADepartment of Urology University of California Los Angeles CADivision of Pediatric Cardiology Department of Pediatrics University of California Los Angeles CADivision of Pediatric Cardiology Department of Pediatrics University of California San Francisco CABackground Prenatal diagnosis of congenital heart disease has been associated with early‐term delivery and cesarean delivery (CD). We implemented a multi‐institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal‐Maternal Consortium. Our objective was to decrease early‐term (37–39 weeks) delivery and CD in pregnancies complicated by fetal congenital heart disease using a SCAMP methodology to improve practice in a high‐risk and clinically complex setting. Methods and Results University of California Fetal‐Maternal Consortium site‐specific management decisions were queried following SCAMP implementation. This contemporary intervention group was compared with a University of California Fetal‐Maternal Consortium historical cohort. Primary outcomes were early‐term delivery and CD. A total of 496 maternal–fetal dyads with prenatally diagnosed congenital heart disease were identified, 185 and 311 in the historical and intervention cohorts, respectively. Recommendation for later delivery resulted in a later gestational age at delivery (38.9 versus 38.1 weeks, P=0.01). After adjusting for maternal age and site, historical controls were more likely to have a CD (odds ratio [OR],1.8; 95% CI, 2.1–2.8; P=0.004) and more likely (OR, 2.1; 95% CI, 1.4–3.3) to have an early‐term delivery than the intervention group. Vaginal delivery was recommended in 77% of the cohort, resulting in 61% vaginal deliveries versus 50% in the control cohort (P=0.03). Among pregnancies with major cardiac lesions (n=373), vaginal birth increased from 51% to 64% (P=0.008) and deliveries ≥39 weeks increased from 33% to 48% (P=0.004). Conclusions Implementation of a SCAMP decreased the rate of early‐term deliveries and CD for prenatal congenital heart disease. Development of clinical pathways may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce healthcare costs.https://www.ahajournals.org/doi/10.1161/JAHA.121.021598cesareanfetal CHDobstetricsprenatal congenital heart diseaseSCAMP |
| spellingShingle | Yalda Afshar Whitnee J. Hogan Charlotte Conturie Sherzana Sunderji Jennifer Y. Duffy Shabnam Peyvandi Nina M. Boe Dora Melber Viviana M. Fajardo Megha D. Tandel Kerry Holliman Lorna Kwan Gary Satou Anita J. Moon‐Grady Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cesarean fetal CHD obstetrics prenatal congenital heart disease SCAMP |
| title | Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan |
| title_full | Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan |
| title_fullStr | Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan |
| title_full_unstemmed | Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan |
| title_short | Multi‐Institutional Practice‐Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan |
| title_sort | multi institutional practice patterns in fetal congenital heart disease following implementation of a standardized clinical assessment and management plan |
| topic | cesarean fetal CHD obstetrics prenatal congenital heart disease SCAMP |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021598 |
| work_keys_str_mv | AT yaldaafshar multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT whitneejhogan multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT charlotteconturie multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT sherzanasunderji multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT jenniferyduffy multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT shabnampeyvandi multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT ninamboe multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT doramelber multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT vivianamfajardo multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT meghadtandel multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT kerryholliman multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT lornakwan multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT garysatou multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan AT anitajmoongrady multiinstitutionalpracticepatternsinfetalcongenitalheartdiseasefollowingimplementationofastandardizedclinicalassessmentandmanagementplan |