Prenatal counseling is the information that parents receive when the unborn baby has a problem: which disorder it has, what can be expected when it is born, both in the short and medium term, and whether there is a solution.
This information, which will help both the father and the mother to be as prepared as possible during the pregnancy and after the childbirth, can be given by the obstetrician, the midwife, and/or the paediatrician, depending on the anomaly.
In the case of congenital heart diseases the paediatric cardiologist should always take part, and he/she should provide information on:
– The risk of other associated malformations outside the heart and of chromosomal alterations, since, although this risk is low, the mere presence of these alterations increases mortality significantly.
– The risk of recurrence or the probability that another similar alteration may be found in a subsequent pregnancy.
– The treatment and survival options in the short and medium term, both in the centre where the child will be born and others nearby, and in the elite centres (in Spain or abroad). The fact of having a congenital heart disease does not mean that the child must necessarily be declared terminally ill. Most congenital heart diseases have a surgical solution with increasingly better results, especially in centres where many cardiac operations are performed.
– The possibilities of intrauterine treatment. This option is possible in some centres and in the case of very specific alterations.
– And finally, the recommendation of intrauterine transport, that is to say, sending mother and child to the centre where that surgery will be carried out before the childbirth (if the baby needs it), as it changes surgery mortality in some diseases. Hence the importance of giving a diagnosis as accurate as possible, because it is not good to refer all pregnant women to centres far from home to give birth, nor for a baby to be born in a centre when it could benefit of some surgery or immediate actions in another hospital prepared for that.
Some congenital heart diseases are difficult to diagnose during the pregnancy, even in expert hands, but although it is not possible to diagnose 100% of cardiopathies, we can get pretty near and, in this way, inform accurately and sensitively parents who are expecting a baby with “a sick heart”.Published on 9 March 2013 in Diario Informacion of Alicante.
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