Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 63

The fetus with congenital heart disease should be carefully followed by ultrasound up to delivery. Structural lesions may evolve prenatally even as they do postnatally. It is particularly important to evaluate areas of potential obstruction, and the relationships of the great arteries to the ventricles. Fetuses with significant arrhythmias (including reentrant tachycardias, atrial flutter, and complete heart block) should also be followed at a center with experience in the prenatal medical management of fetal arrhythmias, by a team that includes perinatologists, pediatric cardiologists, and adult electrophysiologists. Delivery need not be by cesarean except in the presence of selected fetal arrhythmias that do not permit adequate fetal heart rate monitoring. For fetuses with lesions that are expected to render the neonate dependent on ductus arteriosus patency for systemic or pulmonary perfusion, prostaglandin E1 should be available in the nursery at the time of delivery to keep the ductus open.