Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning

Abstract

Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns’ hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.

Management of Ebstein Anomaly in the Current Era: The Story of One Fetus and the Collaboration of Many—A Case Report

“…In the current era, multidisciplinary delivery planning has become central to the prenatal care of families facing a diagnosis of congenital heart disease. Delivery planning includes decisions on timing, mode, and location of delivery [8][9][10][18][19][20], as well as planning for the availability of team members with the skill sets appropriate for the care of the neonate. Multidisciplinary prenatal discussions of this patient prenatally resulted in a thoughtful delivery plan.…”