Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery

Themajority of congenital cardiovascular disease including structural cardiac defects, abnormalities in cardiac function, and rhythmdisturbances can be identified prenatally using screening obstetrical ultrasoundwith referral for fetal echocardiogramwhen indicated. Diagnosis of congenital heart disease in the fetus should prompt assessment for extracardiac abnormalities and associated genetic abnormalities once parental consent is obtained. Pediatric cardiologists, in conjunctionwith maternal-fetalmedicine, neonatology, and cardiothoracic surgery subspecialists, should counsel families about thedetails of the congenitalheart defect aswell asprenatalandpostnatal management. Prenatal diagnosis often leads to increasedmaternal depression and anxiety; however, it decreasesmorbidity andmortality formany congenital heart defects by allowing clinicians the opportunity to optimize prenatal care and plan delivery based on the specific lesion. Changes in prenatal care can includemore frequent assessments through the remainder of the pregnancy, maternalmedication administration, or, in selected cases, in utero cardiac catheter intervention or surgical procedures to optimize postnatal outcomes. Delivery planningmay include changing the location, timingormodeofdelivery toensurethat theneonateisdelivered inthemost appropriate hospital settingwith the required level of hospital staff for immediate postnatal stabilization. Based on the specific congenital heart defect, prenatal echocardiogramassessment in late gestation can often aid in predicting the severity of postnatal instability and guide themedical or interventional level of care needed for immediate postnatal intervention to optimize the transition to postnatal circulation.