Delivery Planning for Complex Congenital Heart Disease

Fetal echocardiography has allowed for an increase in the number of newborns prenatally diagnosed with congenital heart defects (CHD). Assessment of fetal cardiac structure and hemodynamics through serial fetal echocardiography enables the pediatric/fetal cardiologist to predict the risk of potential hemodynamic compromise that a baby with CHD may experience and identify those who may require urgent cardiac interventions necessary for their survival. This chapter reviews fetal cardiovascular physiology, circulatory changes at the time of birth, fetal echocardiographic findings used for risk stratification of newborns with CHD, and principles to guide planning for the resuscitation and initial transitional care of these complex and at-risk neonates.