American Heart Association releases new guidelines for care of fetal heart problems

The American Heart Association and fetal heart experts have developed guidelines for the care of unborn babies with heart problems.

The authors reviewed current literature on the assessment and diagnosis of fetal heart issues, as well as currently available treatment options. The recommendations were created to give healthcare providers the most current information on fetal cardiology.

Some of the recommendations include:

--Referring expectant mothers for fetal echocardiographs if they have risk factors such as diabetes before pregnancy or diabetes diagnosed during the first trimester, usage of non-steroidal anti-inflammatory drugs during the third trimester, or congenital heart disease (CHD) or a familial history of CHD.
--Monitoring fetuses who have been identified with chromosomal problems or other abnormalities.
--Careful monitoring of fetuses diagnosed with heart abnormalities and planning of delivery and post-delivery care.
--Using medicine to treat some heart rhythm disturbances and heart function abnormalities. The use of in utero heart catheterization should be considered experimental.
--Providing counseling and support to expectant parents. Doctors should be able to provide information about the condition, its treatment, and what future care for a child may entail.

Joshua Copel, MD, a member of the Contemporary OB/GYN editorial board and one of the coauthors of the paper, said, “This paper, more of a monograph than a traditional paper, is lengthy and comprehensive, the result of more than 3 years of work from a broad range of pediatric cardiologists and obstetricians. 

“While it contains a wealth of information beyond that needed in everyday obstetric practice, there are several useful parts, especially Tables 2 and 3, which contain indications for fetal echo that should be familiar to all those providing prenatal care to maintain appropriate referral patterns.”

Donofrio M, Moon-Grady A, Hornberger L, et al. Diagnosis and treatment of fetal cardiac disease: A scientific statement from the American Heart Association. Circulation. 2014 (ePub ahead of print).