Integrated pregnancy and perinatal management of complex fetal congenital heart disease: a preliminary retrospective study

BACKGROUND: Congenital heart disease (CHD) is the most prevalent congenital abnormality worldwide and is the primary contributor to neonatal mortality. Obstetricians in China continue to face uncertainties about optimal delivery timing, appropriate delivery mode, perinatal interventions, and postnatal surgical outcomes for fetuses with complex CHD. OBJECTIVE: To investigate integrated pregnancy and perinatal management strategies for fetuses diagnosed with complex CHD by prenatal ultrasound in China. METHODS: A retrospective analysis was performed on 123 fetuses with complex CHD diagnosed by prenatal ultrasound at Peking University People's Hospital between 2016 and 2023. RESULTS: The mean gestational age at ultrasound diagnosis was 23.7 ± 3.4 weeks. Among the 123 cases, 11 (8.9%) were total anomalous pulmonary venous connection (TAPVC), 14 (11.4%) pulmonary valve abnormalities (PVA), 7 (5.7%) right ventricular double outlet (DORV), 13 (10.6%) aortic arch abnormalities, 69 (56.1%) complete transposition of the great arteries (D-TGA), and 9 (7.3%) other types. Following prenatal counseling, all pregnancies were continued. Among the 72 fetuses undergoing prenatal genetic testing, 9 (9/72) showed chromosomal variants. Fifty-five pregnant women (44.72%) attempted trial of labor, of whom 46 (37.40%) achieved vaginal delivery, including 6 (4.88%) assisted with forceps. Trial of labor failed in 9 cases, requiring cesarean section. In total, 77 pregnancies were delivered by cesarean section, yielding a cesarean rate of 62.6%. The mean gestational age at delivery was 37.9 ± 1.4 weeks, and the mean neonatal birth weight was 3099.0 ± 479.6 g. The mean umbilical arterial blood gas pH was 7.31 ± 0.05. Postnatally, 86 infants (69.9%) received prostaglandin. Average oxygen saturation increased from 72.8 ± 6.0% before alprostadil administration to 80.5 ± 5.0% afterward, a statistically significant improvement (p = 0.000). A total of 114 neonates underwent surgical intervention; 98.2% achieved favorable outcomes, whereas two infants (1.8%) died postoperatively. Approximately 13.0% were anticipated to require secondary surgery. CONCLUSION: Pregnancies involving fetuses with complex CHD should avoid preterm birth whenever possible. Complex fetal CHD alone is not an indication for cesarean delivery; the delivery mode should instead be determined by standard obstetric considerations, and individualized management may be adopted according to their opinions and preferences. When both maternal and fetal status remain stable, scheduling delivery at or beyond 39 weeks may be considered. Newborns who present with low postnatal oxygen saturation should receive prostaglandin to keep the ductus arteriosus open, followed by urgent transfer to pediatric cardiac surgery for definitive management. Coordinated, multidisciplinary care supports favorable clinical outcomes.