Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies

E. Araujo Júnior, G. Tonni, M. Chung, Rodrigo Ruano, W. P. Martins

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE: To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD).

METHODS: A systematic review and meta-analysis were performed following an electronic search of PubMed and Scopus databases (last searched August 2015). Perinatal outcomes that were assessed included fetal death, live birth, preterm delivery < 37 weeks' gestation and neonatal death. Intrauterine complications that were assessed included bradycardia requiring treatment and hemopericardium requiring drainage. Estimated proportions were reported as mean (95% CI). Inconsistency was assessed using the I2 statistic.

RESULTS: An electronic search identified 2279 records, of which 29 studies (11 retrospective cohort and 18 case reports) were considered eligible for analysis. Fetal death after treatment of CHD by aortic valvuloplasty was reported in three studies, with a rate of 31% (95% CI, 9-60%), after pulmonary valvuloplasty in one study, with a rate of 25% (95% CI, 10-49%), after septoplasty in one study, with a rate of 14% (95% CI, 6-28%) and after pericardiocentesis and/or pericardioamniotic shunt placement in 24 studies, with a rate of 29% (95% CI, 18-41%). Bradycardia requiring treatment was reported after aortic valvuloplasty in two studies, with a rate of 52% (95% CI, 16-87%), after pulmonary valvuloplasty in one study, with a rate of 44% (95% CI, 23-67%), and after septoplasty in one study, with a rate of 27% (95% CI, 15-43%).

CONCLUSIONS: Current evidence on the effectiveness of prenatal intervention for CHD derives mostly from case reports and a few larger series; no study was randomized. Although the results of the meta-analysis are encouraging in terms of perinatal survival, they should be interpreted with caution when comparing with procedures performed after delivery.

Original languageEnglish (US)
Pages (from-to)426-433
Number of pages8
JournalUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Volume48
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Observational Studies
Meta-Analysis
Heart Diseases
Fetal Death
Bradycardia
Pericardiocentesis
Lung
Pericardial Effusion
Live Birth
PubMed
Drainage
Therapeutics
Retrospective Studies
Databases
Pregnancy
Perinatal Death

Keywords

  • fetal cardiac intervention
  • intrauterine complications
  • pericardiocentesis
  • perinatal outcomes
  • septoplasty
  • valvuloplasty

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

@article{9715e4b659974265afbabdc5865c12bf,
title = "Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies",
abstract = "OBJECTIVE: To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD).METHODS: A systematic review and meta-analysis were performed following an electronic search of PubMed and Scopus databases (last searched August 2015). Perinatal outcomes that were assessed included fetal death, live birth, preterm delivery < 37 weeks' gestation and neonatal death. Intrauterine complications that were assessed included bradycardia requiring treatment and hemopericardium requiring drainage. Estimated proportions were reported as mean (95{\%} CI). Inconsistency was assessed using the I2 statistic.RESULTS: An electronic search identified 2279 records, of which 29 studies (11 retrospective cohort and 18 case reports) were considered eligible for analysis. Fetal death after treatment of CHD by aortic valvuloplasty was reported in three studies, with a rate of 31{\%} (95{\%} CI, 9-60{\%}), after pulmonary valvuloplasty in one study, with a rate of 25{\%} (95{\%} CI, 10-49{\%}), after septoplasty in one study, with a rate of 14{\%} (95{\%} CI, 6-28{\%}) and after pericardiocentesis and/or pericardioamniotic shunt placement in 24 studies, with a rate of 29{\%} (95{\%} CI, 18-41{\%}). Bradycardia requiring treatment was reported after aortic valvuloplasty in two studies, with a rate of 52{\%} (95{\%} CI, 16-87{\%}), after pulmonary valvuloplasty in one study, with a rate of 44{\%} (95{\%} CI, 23-67{\%}), and after septoplasty in one study, with a rate of 27{\%} (95{\%} CI, 15-43{\%}).CONCLUSIONS: Current evidence on the effectiveness of prenatal intervention for CHD derives mostly from case reports and a few larger series; no study was randomized. Although the results of the meta-analysis are encouraging in terms of perinatal survival, they should be interpreted with caution when comparing with procedures performed after delivery.",
keywords = "fetal cardiac intervention, intrauterine complications, pericardiocentesis, perinatal outcomes, septoplasty, valvuloplasty",
author = "{Araujo J{\'u}nior}, E. and G. Tonni and M. Chung and Rodrigo Ruano and Martins, {W. P.}",
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T1 - Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease

T2 - systematic review and meta-analysis of observational studies

AU - Araujo Júnior, E.

AU - Tonni, G.

AU - Chung, M.

AU - Ruano, Rodrigo

AU - Martins, W. P.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE: To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD).METHODS: A systematic review and meta-analysis were performed following an electronic search of PubMed and Scopus databases (last searched August 2015). Perinatal outcomes that were assessed included fetal death, live birth, preterm delivery < 37 weeks' gestation and neonatal death. Intrauterine complications that were assessed included bradycardia requiring treatment and hemopericardium requiring drainage. Estimated proportions were reported as mean (95% CI). Inconsistency was assessed using the I2 statistic.RESULTS: An electronic search identified 2279 records, of which 29 studies (11 retrospective cohort and 18 case reports) were considered eligible for analysis. Fetal death after treatment of CHD by aortic valvuloplasty was reported in three studies, with a rate of 31% (95% CI, 9-60%), after pulmonary valvuloplasty in one study, with a rate of 25% (95% CI, 10-49%), after septoplasty in one study, with a rate of 14% (95% CI, 6-28%) and after pericardiocentesis and/or pericardioamniotic shunt placement in 24 studies, with a rate of 29% (95% CI, 18-41%). Bradycardia requiring treatment was reported after aortic valvuloplasty in two studies, with a rate of 52% (95% CI, 16-87%), after pulmonary valvuloplasty in one study, with a rate of 44% (95% CI, 23-67%), and after septoplasty in one study, with a rate of 27% (95% CI, 15-43%).CONCLUSIONS: Current evidence on the effectiveness of prenatal intervention for CHD derives mostly from case reports and a few larger series; no study was randomized. Although the results of the meta-analysis are encouraging in terms of perinatal survival, they should be interpreted with caution when comparing with procedures performed after delivery.

AB - OBJECTIVE: To assess perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease (CHD).METHODS: A systematic review and meta-analysis were performed following an electronic search of PubMed and Scopus databases (last searched August 2015). Perinatal outcomes that were assessed included fetal death, live birth, preterm delivery < 37 weeks' gestation and neonatal death. Intrauterine complications that were assessed included bradycardia requiring treatment and hemopericardium requiring drainage. Estimated proportions were reported as mean (95% CI). Inconsistency was assessed using the I2 statistic.RESULTS: An electronic search identified 2279 records, of which 29 studies (11 retrospective cohort and 18 case reports) were considered eligible for analysis. Fetal death after treatment of CHD by aortic valvuloplasty was reported in three studies, with a rate of 31% (95% CI, 9-60%), after pulmonary valvuloplasty in one study, with a rate of 25% (95% CI, 10-49%), after septoplasty in one study, with a rate of 14% (95% CI, 6-28%) and after pericardiocentesis and/or pericardioamniotic shunt placement in 24 studies, with a rate of 29% (95% CI, 18-41%). Bradycardia requiring treatment was reported after aortic valvuloplasty in two studies, with a rate of 52% (95% CI, 16-87%), after pulmonary valvuloplasty in one study, with a rate of 44% (95% CI, 23-67%), and after septoplasty in one study, with a rate of 27% (95% CI, 15-43%).CONCLUSIONS: Current evidence on the effectiveness of prenatal intervention for CHD derives mostly from case reports and a few larger series; no study was randomized. Although the results of the meta-analysis are encouraging in terms of perinatal survival, they should be interpreted with caution when comparing with procedures performed after delivery.

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