Abstract
Advances in prenatal imaging have improved the examination of the fetal cardiovascular
system. Fetal echocardiography facilitates the prenatal diagnosis of congenital heart
disease (CHD) and through sequential examination, allows assessment of fetal cardiac
hemodynamics, predicting the evolution of anatomical and functional cardiovascular
abnormalities in utero and during the transition to a postnatal circulation at delivery.
This approach allows detailed diagnosis with prenatal counseling and enables planning
to define perinatal management, selecting the fetuses at a risk of postnatal hemodynamic
instability who are likely to require a specialized delivery plan. The prenatal diagnosis
and management of critical neonatal CHD has been shown to play an important role in
improving the outcome of newborns with these conditions, allowing timely stabilization
of the circulation prior to cardiac intervention or surgery, thus reducing the risk
of perioperative morbidity and mortality. Diagnostic protocols aimed at risk-stratifying
severity and potential postnatal compromise in fetuses with CHD have been developed
to identify those who may require special intervention at birth or within the first
days of life. In addition, new methodologies are being studied to improve the accuracy
of prediction of disease severity. Perinatal management of neonates with a prenatal
diagnosis of CHD requires a close collaboration between obstetric, neonatal, and cardiology
services. In this article, the management of fetuses with CHD will be discussed, along
with summarizing the in utero and fetal echocardiographic findings used for risk stratification
of newborns with CHD and reviewing the basic principles used for planning for neonatal
resuscitation and initial transitional care of these complex newborns.
Keywords
fetal echocardiography - prenatal diagnosis - delivery management - congenital heart
disease
