What do I do if my child has a heart defect?
The finding of a heart defect in the fetus has significant implications for pregnancy management, delivery planning, and diagnosis of abnormalities in other organs.
Structural heart defects
Fetal echocardiography can help detect fetal heart abnormalities before birth, allowing for faster medical or surgical intervention once the baby is born if needed. This improves the chance of survival after delivery for babies with serious heart defects. Your pediatric cardiologist will counsel you about the seriousness of the heart defect and tell you what to expect.
Some heart defects will not require immediate intervention and the baby can be followed at the delivery hospital and as an outpatient after discharge. Other defects are more serious and require transfer to a hospital with pediatric cardiac surgical services immediately after delivery. In a small number of cases, the condition may be severe enough for the pediatric cardiologist to recommend delivery at a pediatric heart center so that an intervention can be performed within minutes of life. In all cases, these issues should be discussed and planned for during the fetal echocardiography visits.
At the current time, prenatal heart surgery and catheterization (balloon procedures) is limited to a small number of conditions and the effectiveness has not been proven. Your pediatric cardiologist can provide information about whether or not your fetus is a potential candidate for fetal intervention, describe the potential benefits and possible risks (to both you and the fetus), and help provide a referral to a fetal intervention center.
Heart rhythm problems
There is a wide range of acceptable fetal heart rates (normal is between 120 and 160 but many normal fetuses have heart rates as low as 90 with no concerns). Many fetuses will have a very short (5 to 10 seconds) drop in heart rate when the sonographer is doing the ultrasound which is a normal variant. It is also very common for the fetus to have occasional premature or early beats that are benign and usually go away shortly after birth. More important fetal heart problems include tachycardia (hear rate too fast) and bradycardia (heart rate too slow).
Some fetuses with tachycardia require medication (given to the mother); in extreme cases this can affect the well being of the fetus. In some cases, you may require being admitted to a labor and delivery unit to receive the medicine so that both your heart and the fetal heart can be monitored. In the case of a rhythm problem that is hard to control, your pediatric cardiologist will work closely with your obstetrician and perinatologist to weigh the risks and benefits of medication and the risk ongoing heart rhythm abnormality in the fetus against the risk of premature delivery.
Some fetuses with extreme bradycardia may have an interruption in the electrical connection between the top and bottom parts of the heart (heart block). In extreme case the well being of the fetus may be affected and a surgical procedure to place a pacemaker may be necessary immediately after birth.
There are a small number of conditions that can be worsened by medications such as indomethacin and your pediatric cardiologist may counsel you about medication dosing in concert with your obstetrician.
Knowing about a potential heart problem prior to delivery also gives a family a chance to learn more about the problem which can help them prepare psychologically for dealing with the extra challenges they may face following birth, such as surgery or other interventions the child may require. In many centers, a coordinated fetal team that includes pediatric cardiologists, genetics counselors, obstetricians, perinatologists, neonatologists, nurses, social workers, and other subspecialists will work closely with you and communicate with each other. Information about fetal heart problems will be sent to your obstetrician and the pediatrician or neonatologists who would likely see the baby immediately following birth.