Labor induction outcomes among patients with cardiovascular disease

To characterize induction of labor (IOL) outcomes in women with cardiovascular disease compared across low and high-risk lesions. A single institution, retrospective cohort study included patients followed in the Cardio-Obstetrics program from 2017-2021 and underwent an IOL. Medical records were reviewed for demographic data including cardiac risk score, reason for presentation to labor and delivery, and mode of delivery. High risk was defined as a CARPREG 2 or greater, indicating a risk of morbidity or mortality of ≥ 10%. 255 medical charts were reviewed. 76 (29%) patients underwent a planned cesarean delivery (CD) and 56 (21%) presented in spontaneous labor, leaving 123 patients for analysis. Of included patients, 62 (50.4%) were high risk. Figure 1 shows the distribution of cardiac lesions. There were no differences in baseline demographics between groups (Table 1). CD was significantly more common in the low risk group, compared to the high risk group (20% v 11%, P=0.02). Only one patient underwent a CD for cardiac indications after an induction of labor in the high risk group. The most common indication for cesarean in the low risk group was non-reassuring fetal status (71%). In patients that underwent a second stage of labor, the length of the second stage of labor was not significantly different between groups (45min v 48min, P=0.77). The total time to delivery (22hr v 25hr, P=0.1663), time to amniotomy (17hr v 25hr, P=0.27) prevalence of epidural usage (91% v 85%, P=0.3767), and mean quantitative blood loss (567cc v 608cc, P=0.63) were not significantly different between groups. Serious maternal cardiac complications (15% v 11%, P=0.82) did not differ, nor did 5-min Apgar score < 7 (5% v 5%, P=1) or NICU admission (15%v 16%, P=0.97). Women with cardiac disease who are deemed candidates for vaginal delivery had equivalent obstetrical outcomes regardless of CARPREG risk category. Vaginal delivery can be supported for most women with cardiac disease. The higher rate of cesarean birth for women with lower cardiac risk scores should be evaluated in other cohorts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)