Perinatal management of fetal cardiac anomalies in a specialized obstetric-pediatrics center

Perinatal teams dealing with fetal heart disease frequently wonder which pr egnancies might be terminated, and when delivery should take place in a spe cialized surrounding. We present a retrospective study of 229 fetuses, in w hich prenatal ultrasound showed a cardiac anomaly not compatible with a sta ndard maternity ward delivery. One hundred nineteen pregnancies were termin ated (group I) while 110 pregnancies led to the birth of a live baby (group II). Pathology in group I was discovered earlier than in group II (24 vs. 29.3 weeks' gestation; p < 0.01), and associated malformations or chromosom al anomalies were much more frequent in group I (80/119 vs. 9/110; p < 0.00 1). Among live born babies, three infants with transposition of the great a rteries underwent Rashkind atrioseptostomy in the delivery room. With a min imum follow-up of 12 months, 69 children (63%) have undergone surgery. Amon g 92 survivors (1 child is lost to follow-up), 78 (71%) are asymptomatic an d 14 symptomatic. Early prenatal diagnosis of fetal heart anomalies significantly facilitates prenatal work-up and perinatal care. We present the types of pathology hav ing led to termination and define the situations in which children are at r isk of perinatal hemodynamic compromise.