VP17.14: Impact of increased surveillance on perinatal management and outcome of fetuses with congenital heart disease
Bibliographic record
Abstract
To examine the clinical impact of frequent antepartum surveillance (FAS) in pregnancies complicated by severe fetal CHD at risk for hydrops/demise. We hypothesised that perinatal outcomes would be improved in those that received FAS. We performed a retrospective chart review of pregnant women managed in our institution from 2003-2019 whose fetuses had severe CHD at risk for hydrops/demise (e.g. Ebsteins anomaly, absent pulmonary valve syndrome, cardiomyopathy), and were planned for active postnatal care. FAS was defined as occurring >1 time/week from 32 weeks of gestation. Of 60 cases, 58% (35/60) had FAS and 42% (25/60) had less frequent surveillance (LFS). Significantly more of those with FAS had livebirths (34/35, 97%) compared with the LFS group (17/25, 68%, p = 0.02). Intrauterine demise (IUFD) and intrapartum death occurred in 12% (3/25) and 20% (5/25) in those with LFS compared with FAS with 3% (1/35) IUFD and no intrapartum deaths (p = 0.02). Neonatal deaths did not differ statistically between groups (LFS 2/17 vs. FAS 12/34, p = 0.08). However, of all high-risk CHD diagnoses, there was improved survival beyond the neonatal period in those with FAS 66%, 22/35 vs. 60%, 15/25, p = 0.05). In 55 with available results, antenatal surveillance was abnormal in 22% (8/35) with FAS compared with 30% (6/20) with LFS (p = 0.34). For those who had an abnormal fetal heart rate, 29% (4/14) had late deceleration/bradycardia with loss of variability and 29% (4/14) had a non-reactive test with either variable deceleration or decreased variability. Overall when surveillance testing was abnormal, there was no significant difference in livebirths (78%, 11/14 vs. 90%, 37/41, p = .24), however there were more neonatal deaths (55%, 6/11 vs. 22%, 8/37, p = 0.04). Our results indicate that abnormal surveillance occurs frequently in high-risk CHD fetuses, suggesting they merit FAS and that FAS may positively impact their perinatal outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".