ABSTRACT
Introduction Advances in prenatal imaging have improved the examination of the fetal heart. Fetal echocardiography is now able to obtain precise details of cardiac structure, function, and blood flow in fetuses with congenital heart disease (CHD) and other anomalies of the cardiovascular system. Serial examination through gestation allows documentation of the evolution of disease in utero and identification of those at risk for compromise that may occur either in utero or during the transition to a postnatal circulation at delivery. It is now recognized that a fetus may benefit from therapy well before birth, and that care of the pregnant woman must be individualized taking into consideration the condition of both patients, mother, and fetus. Detailed cardiac assessment and the increasing understanding of the fetal and transitional circulation has enabled better prediction of those newborns who will be compromised at birth and therefore facilitates the opportunity for detailed planning to define perinatal management, selecting the fetuses at increased risk for postnatal hemodynamic instability who are likely to require specialized care.1-5 The prenatal diagnosis and management of severe or critical CHD allows such specialized care to begin in the delivery room, improving outcome in specific highrisk diagnoses3-5 and potentially reducing the risk of perioperative morbidity,6-12 including the risk of perioperative neurologic insults.13 Despite evidence that fetal diagnosis has improved the outcome of some cardiac defects, there are some more critical forms that may still be associated with significant morbidity and mortality caused by hemodynamic instability that occurs after birth, often shortly after separation from the placental circulation.3 Detailed prenatal assessment including determination of the severity of the defect as well as the anticipated degree of instability and care required at the time of delivery has allowed for disease-specific delivery recommendations to ensure the best care and avoid delays in treatment.3,4,14 Peripartum and delivery room management of fetuses with CHD require collaboration between obstetric, neonatal, and fetal and pediatric cardiology specialists, including detailed communication and cooperation between the delivery hospital and pediatric tertiary care center.2,4 This
chapter reviews data to support current practice for the intrapartum, perinatal, and delivery room care of infants with a prenatal diagnosis of CHD.
