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Published statement offers expert guidance on fetal heart care

Tuesday April 29, 2014
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Fetal heart experts working with the American Heart Association have developed guidelines to help healthcare providers care for unborn babies with heart problems, as well as their families.

The statement, “Diagnosis and Treatment of Fetal Cardiac Disease,” was published April 24 on the website of the journal Circulation.

“Congenital heart disease is the most common birth defect that can result in either death or significant health problems in newborn babies,” Mary T. Donofrio, MD, lead writer of the statement and director, Fetal Heart Program and Critical Care Delivery Service, Children’s National Medical Center, Washington, D.C., said in a news release.

Fetal care is no longer solely the realm of high-risk obstetricians and neonatologists. A multidisciplinary specialty of fetal cardiology has emerged, according to the statement.

“We now have advanced imaging technologies, such as high-resolution ultrasound and three- and four-dimensional echocardiography, magnetic resonance imaging, fetal electrocardiography and magnetocardiography enabling physicians to diagnose fetal abnormalities early and with better detail and accuracy,” Donofrio said.

“Despite this, more than half of babies with congenital heart disease go undiagnosed before birth. We created these guidelines to provide pediatric cardiologists, obstetricians, maternal fetal specialists, radiologists, nurses and other healthcare providers with the latest developments in the rapidly developing area of fetal cardiology.”

Among the recommendations in the statement:

• Pregnant women with specific risk factors should be referred for fetal echocardiography, a technology that uses sound waves to examine the fetal heart. Women at risk include those who have had diabetes before pregnancy or diabetes diagnosed in the first trimester, have taken NSAIDs in their third trimester, have congenital heart disease or a close relative with congenital heart disease, or other specific maternal medical conditions, and possibly those who conceived with in vitro fertilization.

Fetuses at risk include those identified with a chromosome problem or other abnormality, or those with a suspected heart problem. Fetuses diagnosed with a heart abnormality should be carefully monitored and healthcare providers should plan the delivery and post-delivery care that the baby will need.

• Some fetal heart rhythm disturbances or heart function abnormalities can be treated with medicines that are given to the mother and reach the fetus by crossing the placenta. In-utero heart catheterization and surgical procedures are being performed but are considered experimental.

The psychological effects and depression that may result when a pregnant woman and her family learn that their child has a congenital heart abnormality also are important factors for healthcare providers to consider. Parents often grieve upon learning that their unborn baby has a congenital heart condition. Providers should offer families information in an unbiased way, which not only addresses the condition and what’s involved in treatment, but also whether children will be able to play sports, do well in school and what kind of physical and mental support they might need, the authors noted. In addition, providers should help families overcome anxiety and depression, so they can transition from grief to acceptance and become active members of the team caring for their baby.

“This document transcends specialties and gives all healthcare providers that practice fetal cardiac medicine a standard for practice,” Donofrio said. “This means improved care for babies with congenital heart disease, starting in the womb and continuing after delivery and through their lives.”

Circulation is a journal of the American Heart Association. Statement: http://circ.ahajournals.org/content/early/2014/04/23/01.cir.0000437597.44550.5d.abstract


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