Implementation of a standardized clinical assessment and management plan (SCAMP) for pregnancies with a prenatal congenital heart disease (CHD) diagnosis resulted in decreased early-term and cesarean deliveries. These findings were published in the Journal of the American Heart Association.
The University of California Fetal Consortium comprised centers affiliated with 5 University of California medical centers. The SCAMP was designed to decrease resource utilization, standardize patient care, and improve clinical outcomes. Between 2018 and 2019, the SCAMP was implemented, and instances of early-term or cesarean deliveries were compared with historical data collected between 2011 and 2013.
A total of 311 maternal-fetal dyads were included from the intervention and 185 from the historical cohorts. Women in the SCAMP cohort were significantly older (median, 33; interquartile range [IQR], 28-37 years) than the controls (median, 32; IQR, 26-36 years; P =.004).
Live births occurred among 98% of the SCAMP cohort. Babies had CHD graded as low risk (35%), minimal risk of hemodynamic instability (49%), likely hemodynamic instability (8%), expected hemodynamic instability (5%), or unknown (3%).
Adherence to the SCAMP was acceptable, in which 80% of women were recommended for genetic counseling, 80% had a planned antenatal test, and 67% were tested twice weekly.
Most women (88%) planned to deliver at ³39 weeks’ gestation, however, only 48% delivered at that time. Early deliveries occurred due to spontaneous labor (37%), maternal indication (31%), noncardiac fetal indication (25%), or other motivations (7%).
A vaginal delivery was planned among 77% but only occurred among 61%. The successful vaginal deliveries were spontaneous (39%) or induced (61%).
Compared with the historical cohort, no significant differences in the planned mode of delivery were reported (P =.162), but more women in the historical cohort planned to deliver <39 weeks’ gestation (66% vs 35%; P <.0001). At delivery, more women in the intervention cohort delivered vaginally (61% vs 50%; P =.026) and at ³39 weeks’ gestation (48% vs 34%; P =.001).
Among only the high risk CHD subset, the SCAMP intervention associated with decreased cesarean deliveries (36% vs 49%; P =.008) and birth before 39 weeks’ gestation (52% vs 67%; P =.004).
This study may have been biased by the fact that the comparator group gave birth ~7 years prior to the intervention cohort. Nevertheless, this data provides evidence that a SCAMP for prenatal CHD pregnancy care can potentially decrease preterm or cesarean deliveries.
Afshar Y, Hogan WJ, Conturie C, et al. 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. s