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Am J Perinatol
DOI: 10.1055/a-2672-2713
Original Article

Neonatal Outcomes in Transposition of the Great Arteries by Mode and Timing of Delivery

Helen B. Gomez Slagle 
1   Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
,
Maria Andrikopoulou 
1   Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
,
Russell Miller
1   Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
,
Yijia Zhang
2   Department of Obstetrics and Gynecology and Department of Epidemiology, Columbia University, New York, New York
,
Angelica M. Vasquez
3   Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
,
Lynn L. Simpson
1   Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
› Author Affiliations
Funding None.
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Abstract

Objective

We aimed to assess neonatal outcomes by mode of delivery and to evaluate the value of achieving daytime delivery among neonates undergoing a planned induction of labor (IOL).

Study Design

This was a retrospective study of pregnancies with prenatally diagnosed d-TGA with an IVS receiving care at a single tertiary care referral center from 2020 to 2023. Inclusion required prenatal diagnosis of d-TGA with an IVS and surgical care at the referral center. The primary outcome was a composite of neonatal outcomes, including preoperative inhaled nitric oxide use, inotrope use, preoperative mortality, reoperation, readmission, delayed sternal closure, diaphragmatic paralysis, and postoperative mortality. Secondary surgical outcomes and composite neurological morbidity, including hypoxic-ischemic encephalopathy, seizures, intraventricular hemorrhage, or stroke, were collected. Pearson's chi-square or Fisher's exact test was performed as appropriate.

Results

We identified 90 cases of prenatally diagnosed d-TGA, of which 68 (76%) underwent timed IOL and 46 (68%) achieved vaginal delivery. The primary outcome occurred in 16 neonates (89%) who were delivered by cesarean and 47 neonates (78%) who underwent a planned timed IOL (p = 0.26). Among individuals undergoing IOL, the primary outcome occurred in 29 neonates (73%) who delivered during the daytime and 18 (90%) who delivered after-hours (p = 0.19).

Conclusion

We found that in cases of prenatally diagnosed d-TGA with an IVS, IOL is feasible. Neonates with d-TGA with an IVS had similar surgical outcomes when induced and delivered at this single tertiary care center, regardless of delivery time.

Key Points

  • Induction is feasible, and daytime delivery was achieved in the majority of cases of TGA.

  • Neonates with d-TGA with an IVS have similar surgical outcomes regardless of delivery time.

  • There was no clear benefit to achieving strict daytime delivery in cases of TGA.

Keywords

transposition - fetal - ultrasound - neonatal - cardiac - outcomes

Ethical Approval

Columbia University Institutional Review Board approved this study onApril 9, 2024 (IRB approval no.: AAAU7212).


Patient Consent

This was a retrospective study, and informed consent was waived as the research posed minimal to no risk to the subjects.


Authors' Contributions

All listed authors have contributed to the manuscript substantially and have agreed to the final submitted version. Study conception and design: H.B.G.S., L.L.S., and A.M.V. Data Acquisition, analysis, and interpretation: H.B.G.S., Y.Z., L.L.S., and A.M.V. Manuscript drafting and revision: H.B.G.S., R.S.M., M.A., A.M.V., and LLS.




Publication History

Received: 12 February 2025

Accepted: 30 July 2025

Accepted Manuscript online:
30 July 2025

Article published online:
11 August 2025

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