907: Multi-institutional practice patterns in fetal CHD following a standardized clinical assessment and management plan

Prenatal diagnosis of congenital heart disease (CHD) has been associated with early-term delivery and cesarean delivery (CD). We sought to implement a multi-institutional standardized clinical assessment and management plan (SCAMP) to determine a best practice by examining differences in practices and outcomes through the University of California Fetal-Maternal Consortium (UCfC). Our objective was to identify triggers leading to early-term delivery and CD of fetal CHD, and to develop a SCAMP to decrease these outcomes. UCfC site-specific management decisions were queried prospectively during prenatal care. Maternal and neonatal chart abstraction was completed at the five UCfC institutions following implementation of the SCAMP in May 2018. Primary outcomes were early-term delivery and CD. Descriptive statistics were used and comparisons with previously published data from our group were made. 224 pregnancies with prenatally diagnosed fetal CHD were identified. Mean gestational age at delivery was 37.9 (± 2.1) weeks. 52% of deliveries occurred at < 39 weeks, a decrease from 67% prior to SCAMP implementation. CD was planned in 22% of pregnancies, a decrease from 37%. 65.7% of inductions at ≥39 weeks were scheduled to coordinate delivery planning. Actual mode of delivery was: spontaneous vaginal delivery 25% (n=56), induction of labor 33% (n=74), CD 42% (n=94). Indications for CD included: repeat 37.2% (n=35), malpresentation 31.3% (n=20), arrest disorders 11.7% (n=11), and non-reassuring fetal heart tracing 29.8% (n=28). Antenatal testing was recommended in 75.5%. Of these, 67.3% started at 32 weeks’ gestation, and 66.1% recommended twice weekly. Abnormal antenatal testing led to a modification in intended delivery plan 9.1% of the time. Implementation of a SCAMP in a multi-institutional cohort significantly decreased the rate of early-term delivery and planned CD for fetal CHD. Development of clinical pathways incorporating these practices may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce health care costs.