Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 77

Several clinical scenarios may warrant fetal echocardiography, which is discussed in more detail in Protocol 6. The ideal time to obtain a fetal echocardiogram is between 18 and 22 weeks of gestation; however, there are several specialized perinatal centers performing this in the first trimester. Counseling and management of the patient with a congenital heart defect involves a variety of steps that include defining the type and severity of cardiac lesion, consideration of the patient’s moral and religious disposition, genetic testing of the fetus (e.g., karyotype, chromosomal microarray, 22Q testing, etc.), and the presence of extracardiac abnormalities. In many instances, one of the most important things to determine in a fetus with congenital heart disease is whether the cardiac lesion will be ductal dependent and require newborn prostaglandin administration to maintain patency of the ductus arteriosus. This is an important step in the management of the pregnant patient, as it will determine whether she needs to be delivered in a hospital with a nursery capable of administering IV prostaglandin.

Fetal arrhythmias are typically first detected incidentally by routine Doppler auscultation during a prenatal clinic visit or by external electronic fetal monitoring. Further identification of the specific type of arrhythmia requires the use of M‐mode cardiography and full assessment of the cardiac structure and flow velocities. Some patients with autoimmune conditions will be SSA/SSB antibody positive and require serial fetal echo for evaluation of P‐R intervals as one indicator of risk for developing complete heart block.

Management of a patient with congenital heart disease should be a collaborative effort with a team consisting of a perinatologist, genetic counselor, pediatric cardiologist, neonatologist, pediatric cardiothoracic surgeon, and the primary obstetrical provider.