Skip to main content Accessibility help
Hostname: page-component-77c89778f8-gvh9x Total loading time: 0 Render date: 2024-07-21T17:52:05.110Z Has data issue: false hasContentIssue false

Section 3 - Antenatal Care: Fetal Considerations

Published online by Cambridge University Press:  05 March 2016

Philip J. Steer
Chelsea and Westminster Hospital, London
Michael A. Gatzoulis
Royal Brompton Hospital, London
Get access


Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Hoffman, JI, et al. Congenital heart disease in a cohort of 19,502 births with long-term follow up. Am J Cardiol, 1978. 42(4):641–7.CrossRefGoogle Scholar
Hoffman, JI. Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol, 1995. 16(4):155–65.Google Scholar
Carvalho, JS, et al. ISUOG Practice Guidelines (updated): Sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol, 2013. 41(3):348–59.Google Scholar
Khairy, P, et al. Changing mortality in congenital heart disease. J Am Coll Cardiol, 2010. 56(14):1149–57.CrossRefGoogle ScholarPubMed
Allan, LD, et al. Outcome after prenatal diagnosis of the hypoplastic left heart syndrome. Heart, 1998. 79(4):371–3.Google Scholar
Bonnet, D, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation, 1999. 99(7):916–18.CrossRefGoogle ScholarPubMed
Franklin, O, et al. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart, 2002. 87(1):67–9.CrossRefGoogle ScholarPubMed
Tworetzky, W, et al. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation, 2001. 103(9):1269–73.CrossRefGoogle ScholarPubMed
Kumar, RK, et al. Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. Am J Cardiol, 1999. 83(12):1649–53.CrossRefGoogle ScholarPubMed
Mahle, WT, et al. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics, 2001. 107(6):1277–82.Google Scholar
Bahado-Singh, RO, et al. Elevated first-trimester nuchal translucency increases the risk of congenital heart defects. Am J Obstet Gynecol, 2005. 192(5):1357–61.Google Scholar
Bull, C. Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. British Paediatric Cardiac Association. Lancet, 1999. 354(9186):1242–7.CrossRefGoogle ScholarPubMed
Jenkins, KJ, et al. Noninherited risk factors and congenital cardiovascular defects: Current knowledge: A scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: Endorsed by the American Academy of Pediatrics. Circulation, 2007. 115(23):29953014.Google Scholar
Friedman, DM, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: The PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation, 2008. 117(4):485–93.CrossRefGoogle ScholarPubMed
Cuneo, BF, et al. Spontaneous rupture of atrioventricular valve tensor apparatus as late manifestation of anti-Ro/SSA antibody-mediated cardiac disease. Am J Cardiol, 2011. 107(5):761–6.Google Scholar
Jaeggi, E, et al. The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus a prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol, 2010. 55(24):2778–84.CrossRefGoogle ScholarPubMed
Hoffman, JI. Congenital heart disease: Incidence and inheritance. Pediatr Clin North Am, 1990. 37(1):2543.Google Scholar
Blue, GM, et al. Congenital heart disease: Current knowledge about causes and inheritance. Med J Aust, 2012. 197(3):155–9.CrossRefGoogle ScholarPubMed
Gill, HK, et al. Patterns of recurrence of congenital heart disease: An analysis of 6,640 consecutive pregnancies evaluated by detailed fetal echocardiography. J Am Coll Cardiol, 2003. 42(5):923–9.CrossRefGoogle Scholar
Rowland, TW, et al. Congenital heart disease in infants of diabetic mothers. J Pediatr, 1973. 83(5):815–20.CrossRefGoogle ScholarPubMed
Wren, C, et al. Cardiovascular malformations in infants of diabetic mothers. Heart, 2003. 89(10):1217–20.CrossRefGoogle ScholarPubMed
Lenke, RR, et al. Maternal phenylketonuria and hyperphenylalaninemia. An international survey of the outcome of untreated and treated pregnancies. N Engl J Med, 1980. 303(21):1202–8.CrossRefGoogle ScholarPubMed
Prick, BW, et al. Maternal phenylketonuria and hyperphenylalaninemia in pregnancy: Pregnancy complications and neonatal sequelae in untreated and treated pregnancies. Am J Clin Nutr, 2012. 95(2):374–82.Google Scholar
Ionescu-Ittu, R, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: Time trend analysis in Quebec, Canada. BMJ, 2009. 338:b1673.Google Scholar
Bailey, LB, et al. Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage. Am J Clin Nutr, 2005. 81(5):1213S-1217S.Google Scholar
Hyett, J, et al. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10–14 weeks of gestation: Population based cohort study. BMJ, 1999. 318(7176):81–5.Google Scholar
Carvalho, JS, The fetal heart or the lymphatic system or …? The quest for the etiology of increased nuchal translucency. Ultrasound Obstet Gynecol, 2005. 25(3):215–20.CrossRefGoogle ScholarPubMed
Nicolaides, KH, et al. Increased fetal nuchal translucency at 11–14 weeks. Prenat Diagn, 2002. 22(4):308–15.Google Scholar
Copel, JA, et al. Congenital heart disease and extracardiac anomalies: Associations and indications for fetal echocardiography. Am J Obstet Gynecol, 1986. 154(5):1121–32.Google Scholar
Greenwood, RD, et al. Cardiovascular abnormalities associated with congenital diaphragmatic hernia. Pediatrics, 1976. 57(1):92–7.CrossRefGoogle ScholarPubMed
Song, MS, et al. Extracardiac lesions and chromosomal abnormalities associated with major fetal heart defects: Comparison of intrauterine, postnatal and postmortem diagnoses. Ultrasound Obstet Gynecol, 2009. 33(5):552–9.Google Scholar
Ferencz, C, et al. Congenital cardiovascular malformations associated with chromosome abnormalities: An epidemiologic study. J Pediatr, 1989. 114(1):7986.Google Scholar
Hornberger, LK, et al. Left heart obstructive lesions and left ventricular growth in the midtrimester fetus. A longitudinal study. Circulation, 1995. 92(6):1531–8.CrossRefGoogle ScholarPubMed
Hornberger, LK, et al. In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol, 1995. 25(3):739–45.CrossRefGoogle ScholarPubMed
Fishman, NH, et al. Models of congenital heart disease in fetal lambs. Circulation, 1978. 58(2):354–64.Google Scholar
Cohn, HE, et al. Cardiovascular responses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol, 1974. 120(6):817–24.Google Scholar
Rosenthal, GL. Patterns of prenatal growth among infants with cardiovascular malformations: Possible fetal hemodynamic effects. Am J Epidemiol, 1996. 143(5):505–13.CrossRefGoogle ScholarPubMed
Mahle, WT, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation, 2002. 106(12 Suppl 1):I109–14.Google Scholar
Andrews, RE, et al. Outcome after preterm delivery of infants antenatally diagnosed with congenital heart disease. J Pediatr, 2006. 148(2):213–6.CrossRefGoogle ScholarPubMed
Costello, JM, et al. Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics, 2010. 126(2):277–84.CrossRefGoogle ScholarPubMed
Morris, SA, et al. Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation, 2014. 129(3):285–92.CrossRefGoogle ScholarPubMed
Jowett, VC, et al. Foetal congenital heart disease: Obstetric management and time to first cardiac intervention in babies delivered at a tertiary centre. Cardiol Young, 2014. 24(3):494502.Google Scholar
Friedman, DM, et al. Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol, 2009. 103(8):1102–6.CrossRefGoogle ScholarPubMed
Reynolds, RM. Glucocorticoid excess and the developmental origins of disease: Two decades of testing the hypothesis–2012 Curt Richter Award Winner. Psychoneuroendocrinology, 2013. 38(1):111.Google Scholar
Freud, LR, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: Postnatal outcomes of the first 100 patients. Circulation, 2014. 130(8):638–45.Google Scholar
Carvalho, JS, et al. First-trimester transabdominal fetal echocardiography. Lancet, 1998. 351(9108):1023–7.Google Scholar
Pike, JI, et al. Early fetal echocardiography: Congenital heart disease detection and diagnostic accuracy in the hands of an experienced fetal cardiology program. Prenat Diagn, 2014. 34(8):790–6.CrossRefGoogle ScholarPubMed
Iliescu, D, et al. Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol. Ultrasound Obstet Gynecol, 2013. 42(3):300–9.CrossRefGoogle ScholarPubMed
Godfrey, ME, et al. Functional assessment of the fetal heart: A review. Ultrasound Obstet Gynecol, 2012. 39(2):131–44.Google Scholar


Cantwell, R, Clutton-Brock, T, Cooper, G et al. Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the UK. BJOG 2011;188(Suppl 1):1203.Google Scholar
Nieminen, HP, Jokinen, EV, Sairanen, HI. Late results of pediatric cardiac surgery in Finland: A population-based study with 96% follow-up. Circulation. 2001;104:570–5.CrossRefGoogle ScholarPubMed
Papageorghiou, AT, Yu, CKH, Bindra, R, Pandis, G, Nicolaides, KN. Multicentre screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001;18:441–9.Google Scholar
Clark, SL. Cardiac disease in pregnancy. Obstet Gynecol Clin North Am 1991;18:237–56.CrossRefGoogle ScholarPubMed
Clark, SL. Labor and delivery in the patient with structural cardiac disease. Clin Perinatol 1986;13:695703.Google Scholar
Siu, SC, Sermer, M, Harrison, DA, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation 1997;96:2789–94.Google Scholar
Curry, RA, Fletcher, C, Gelson, E, et al. Pulmonary hypertension and pregnancy–a review of 12 pregnancies in nine women. Br J Obstet Gynaecol 2012;119:752–61.Google Scholar
Whittemore, R, Hobbins, JC, Engle, MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 1982;50:641–51.Google Scholar
Presbitero, P, Somerville, J, Stone, S, et al. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 1994;89:2673–6.Google Scholar
Chia, P, Raman, S, Tham, SW. The pregnancy outcome of acyanotic heart disease. J Obstet Gynaecol Res 1998;24:267–73.Google Scholar
Gleicher, N, Midwall, J, Hochberger, D, et al. Eisenmenger’s syndrome and pregnancy. Obstet Gynecol Surv 1979;34:721–41.Google Scholar
Sawhney, H, Suri, V, Vasishta, K, et al. Pregnancy and congenital heart disease—maternal and fetal outcome. Aust N Z J Obstet Gynaecol 1998;38:266–71.Google Scholar
Pedersen, LM, Pedersen, TA, Ravn, HB, et al. Outcomes of pregnancy in women with tetralogy of Fallot. Cardiol Young 2008;18:423–9.Google Scholar
Canobbio, MM, Mair, DD, van der Velde, M, et al. Pregnancy outcomes after the Fontan repair. J Am Coll Cardiol 1996;28:763–7.Google Scholar
Hameed, AH, Karaalp, IS, Tummala, PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol 2001;37:893–9.CrossRefGoogle ScholarPubMed
Malhotra, M, Sharma, JB, Tripathii, R, et al. Maternal and fetal outcome in valvular heart disease. Int J Gynaecol Obstet 2004;84:1116.Google Scholar
Burn, J, Brennan, P, Little, J, et al. Recurrence risks in offspring of adults with major heart defects: Results from first cohort of British collaborative study. Lancet 1998;351:311–16.Google Scholar
Nora, JJ. From generational studies to a multilevel genetic-environmental interaction. J Am Coll Cardiol 1994;23:1468–71.Google Scholar
Gill, HK, Splitt, M, Sharland, GK, Simpson, JM. Patterns of recurrence of congenital heart disease: An analysis of 6,640 consecutive pregnancies evaluated by detailed fetal echocardiography. J Am Coll Cardiol 2003;42:923–9.Google Scholar
Nora, JJ, Nora, AH. The evolution of specific genetic and environmental counseling in congenital heart diseases. Circulation 1978;57:205–13.Google Scholar
Hyett, J, Moscoso, G, Nicolaides, K. Abnormalities of the heart and great arteries in first trimester chromosomally abnormal fetuses. Am J Med Genet 1997;69:207–16.Google Scholar
Moyano, D, Huggon, IC, Allan, LD. Fetal echocardiography in trisomy 18. Arch Dis Child Fetal Neonatal Ed 2005;90:F520–2.Google Scholar
Surerus, E, Huggon, IC, Allan, LD. Turner’s syndrome in fetal life. Ultrasound Obstet Gynecol 2003;22:264–7.Google Scholar
Hyett, J, Perdu, M, Sharland, G, et al. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10–14 weeks of gestation: Population based cohort study. BMJ 1999;318:70–1.CrossRefGoogle ScholarPubMed
Makrydimas, G, Sotiriadis, A, Huggon, IC, et al. Nuchal translucency and fetal cardiac defects: A pooled analysis of major fetal echocardiography centers. Am J Obstet Gynecol 2005;192:8995.Google Scholar
Mogra, R, Alabbad, N, Hyett, J. Increased nuchal translucency and congenital heart disease. Early Hum Dev 2012;88:261–7.CrossRefGoogle ScholarPubMed
Atzei, A, Gajewska, K, Huggon, IC, et al. Relationship between nuchal translucency thickness and prevalence of major cardiac defects in fetuses with normal karyotype. Ultrasound Obstet Gynecol 2005;26:154–7.Google Scholar
Huggon, IC, Ghi, T, Cook, AC, et al. Fetal cardiac abnormalities identified prior to 14 weeks’ gestation. Ultrasound Obstet Gynecol 2002;20:22–9.Google Scholar
Maiz, N, Plasencia, W, Dagklis, T, et al. Ductus venosus Doppler in fetuses with cardiac defects and increased nuchal translucency thickness. Ultrasound Obstet Gynecol 2008;31:256–60.CrossRefGoogle ScholarPubMed
Pereira, S, Ganapathy, R, Syngelaki, A, et al. Contribution of fetal tricuspid regurgitation in first-trimester screening for major cardiac defects. Obstet Gynecol 2011;117:1384–91.Google Scholar
Rasiah, SV, Publicover, M, Ewer, AK, et al. A systematic review of the accuracy of first-trimester ultrasound examination for detecting major congenital heart disease. Ultrasound Obstet Gynecol 2006;28:110–16.CrossRefGoogle ScholarPubMed
Khalil, A, Nicolaides, KH. Fetal heart defects: Potential and pitfalls of first-trimester detection. Semin Fetal Neonatal Med 2013;18:251–60.Google Scholar
Gelson, E, Curry, R, Gatzoulis, MA, et al. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011;117:886–91.Google Scholar
Papageorghiou, AT, Yu, CK, Nicolaides, KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2004;18:383–96.Google Scholar
Carbillon, L, Challier, JC, Alouini, S, et al. Uteroplacental circulation development: Doppler assessment and clinical importance. Placenta 2001;22:795–9.Google Scholar
Sagol, S, Ozkinay, E, Oztekin, K, et al. The comparison of uterine artery Doppler velocimetry with the histopathology of the placental bed. Aust N Z J Obstet Gynaecol 1999;39:324–9.Google Scholar
Neilson, JP, Alfirevic, Z. Doppler ultrasound for fetal assessment in high-risk pregnancies. Cochrane Database Syst Rev 2000;(2):CD000073.Google ScholarPubMed
Madazli, R, Somunkiran, A, Calay, Z, et al. Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 2003;24:510–16.Google Scholar
Karsdorp, VH, van Vugt, JM, Van Geijn, HP, et al. Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Lancet 1994;344:1664–8.CrossRefGoogle ScholarPubMed
Pattinson, RC, Norman, K, Odendaal, HJ. The role of Doppler velocimetry in the management of high-risk pregnancies. Br J Obstet Gynaecol 1994;101:114–20.Google Scholar
Todros, T, Ronco, G, Fianchino, O, et al. Accuracy of the umbilical arteries Doppler flow velocity waveforms in detecting adverse perinatal outcomes in a high-risk population. Acta Obstet Gynecol Scand 1996;75:113–19.Google Scholar
Baschat, AA. Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction. Ultrasound Obstet Gynecol 2011;37:501–14.Google Scholar
Baschat, AA, Gembruch, U, Reiss, I, et al. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol 2000;16:407–13.CrossRefGoogle ScholarPubMed
Bilardo, CM, Wolf, H, Stigter, RH, et al. Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet Gynecol 2004;23:119–25.Google Scholar
Coomarasamy, A, Fisk, NM, Gee, H, et al. Investigation and Management of the Small-for-Gestational Age Fetus. Guideline No. 31. London: Guidelines and Audit Committee of the Royal College of Obstetricians and Gynaecologists, 2002.Google Scholar
Suri, V, Keepanasseril, A, Aggarwal, N, et al. Maternal complete heart block in pregnancy: Analysis of four cases and review. of management. J Obstet Gynaecol Res 2009;35:434–7.Google Scholar
Weiss, BM, von Segesser, LK, Alon, E, et al. Outcome of cardiovascular surgery and pregnancy: A systematic review of the period 1984–1996. Am J Obstet Gynecol 1998;179:1643–53.Google Scholar
Chambers, CE, Clark, SL. Cardiac surgery during pregnancy. Clin Obstet Gynecol 1994;37:316–23.Google Scholar
Pomini, F, Merccogliano, D, Cavaletti, C, et al. Cardiopulmonary bypass in pregnancy. Ann Thorac Surg 1996;61:259–68.Google Scholar
Kalra, GS, Arora, R, Khan, JA, et al. Percutaneous mitral commissurotomy for severe mitral stenosis during pregnancy. Cathet Cardiovasc Diagn 1994;33:2830.Google Scholar
Mahli, A, Izdes, S, Coskun, D. Cardiac operations during pregnancy: Review of factors influencing fetal outcome. Ann Thorac Surg 2000;69:1622–6.Google Scholar
Sepehripour, AH, Lo, TT, Shipolini, AR, et al. Can pregnant women be safely placed on cardiopulmonary bypass? Interact Cardiovasc Thorac Surg 2012;15:1063–71.Google Scholar
Chandrasekhar, S, Cook, CR, Collard, CD. Cardiac surgery in the parturient. Anesth Analg 2009;108:777–85.Google Scholar
Cheek, DB, Hughes, SC, Dailey, PA, et al. Effect of halothane on regional cerebral blood flow and cerebral metabolic oxygen consumption in the fetal lamb in utero. Anesthesiology 1987;67:361–6.CrossRefGoogle ScholarPubMed
Liu, PL, Warren, TM, Ostheimer, GW, et al. Foetal monitoring in parturients undergoing surgery unrelated to pregnancy. Can Anaesth Soc J 1985;32:525–32.Google Scholar
. Conroy, JM, Bailey, MK, Hollon, MF, et al. Anesthesia for open heart surgery in the pregnant patient. South Med J 1989;82:492–5.CrossRefGoogle ScholarPubMed
Salerno, TA, Houck, JP, Barrozo, CA, et al. Retrograde continuous warm blood cardioplegia: A new concept in myocardial protection. Ann Thorac Surg 1991;51:245–9.Google Scholar
Khandelwal, M, Rasanen, J, Ludormirski, A, Addonizio, P, Reece, EA. Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass. Obstet Gynecol 1996;88:667–71.Google Scholar
Draper, ES, Manktelow, B, Field, DJ, James, D. Prediction of survival for preterm births by weight and gestational age: Retrospective population based study. BMJ 1999;319:1093–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats