Foetal heart defects are not always a reason to terminate pregnancy |

Receiving a diagnosis of a heart defect in your unborn child can be an incredibly (emotional) overwhelming experience for parents-to-be. It is entirely understandable that fear and uncertainty come to mind at this time. As a result, the reaction from many families is to immediately assume the worst and looks at terminating the pregnancy. As a paediatric cardiologist who cares for many of the children that have congenital heart disease, there is a very important message that I would like to convey: Not all foetal heart defects will lead to a termination of pregnancy. Because of current advances in diagnostics, medical care, and surgical methods, the vast majority of children with heart defects will be able to enjoy healthy, productive lives.Congenital heart defects (CHD) are the most common type of birth defect and affect more than 1 in 100 births globally. Congenital heart defects can vary greatly, from the simplest congenital heart defects that may resolve on their own or require little to no medical intervention, to the most complex congenital heart defects that require extensive monitoring and intervention over time. A diagnosis of a potential heart defect from a fetal ultrasound will not automatically mean that the heart defect is life-altering and/or uncorrectable. Many heart defects can be treated either before birth, immediately after birth, or later during childhood with very successful outcomes.Once a potential diagnosis has been identified, the next step will be a thorough assessment by a team of specialists, including a fetal cardiologist. During this evaluation, a detailed fetal echocardiogram (a specialized ultrasound technique) will typically be performed to allow for visualization of the anatomy and physiological functioning of the developing heart. This is a critical test because it can differentiate between defects requiring urgent postnatal treatment and those that may be benign or have a spontaneous resolution.In some cases, like Small Ventricular Septal Defects (holes in the heart chambers) and Atrial Septal Defects, the defect may close on its own as the child gets older. In other cases, such as Mild Pulmonary Stenosis, treatment can often be monitored and performed with a minimally invasive procedure after birth. The majority of cases are not complex and do not require multiple staged surgeries. In those cases where multiple staged surgeries are necessary, surgical techniques and perioperative care have dramatically improved, resulting in high survival rates and quality of life.Parental stress is further exacerbated by the apprehension that their child may have permanent disability. Although there may be an element of truth to this for some congenital heart diseases, there is also evidence to suggest that a majority of children with congenital heart defects will continue to develop normally; attend school, play sports or participate in other normal activities; and ultimately live productive and fulfilling lives. An early diagnosis and coordinated care plan, ideally involving a multi-disciplinary healthcare team, will assist parents in emotionally and medically preparing for their child’s care rather than responding out of fear alone.A very important thing is to provide counselling. When a foetal heart defect is found there should be a full counselling session so that parents can ask questions, know what happens next, and meet with physicians who can explain what happens next. Parents will also need emotional support, ideally in conjunction with their medical counselling, as they go through this process. The decision to continue the pregnancy should only be done after having full information and the opportunity to seek advice from experts.Besides, there are professionals who evaluate as well as support groups or networks made up of families that have been through a similar experience. Hearing another parent whose child’s surgery went well (and is now doing well) can help ease worry and promote hope.The landscape surrounding congenital heart disease treatment has drastically changed in the last few decades. What was once seen as a serious illness has frequently become an issue that can be managed effectively. Here at BM Birla Heart Hospital we have had many success stories where babies with congenital heart defects have gone on to be happy, healthy children and adults thanks to advances in paediatric cardiology and the strength of the family.If you do have a prenatal echocardiogram showing a heart defect , please remember to stop and ask for additional specialist review . A diagnosis is only the beginning of a journey toward an informed, supported journey to the best outcome for both mother and child; many infants with congenital heart disease have strong, long-lasting futures with proper care, clear information, and positive support.Dr. Madhurima Ghosh, Paediatric Cardiologist, BM Birla Heart Hospital