Integration of palliative care for severe cardiac abnormalities diagnosed during pregnancy

Şef de lucr. univ. Dr. Anca Angela Simionescu
Universitatea de Medicină si Farmacie “Carol Davila”, București, România, Obstetrică-ginecologie

Abstract

Pre- and postnatal cardiac malformations represent a special category of chronic and terminal disease, which requires postnatal palliative care. Congenital heart defects can be isolated, non-severe or severe-critical. Congenital heart defects may be associated with other structural abnormalities, genetic or chromosomal syndromes. Because fetal cardiac malformations are no longer considered as an indication of therapeutic termination of pregnancy, we propose in this article to discuss the problem of palliative care for prenatal diagnosed cardiac malformations. Childbirth will take place in specialized centers and maternity, the coordination of the multidisciplinary teams and the medical care protocols will prolong the survival and optimize the management of these patients.

Palliative care services will improve the comfort of the critical patient, not focusing on improving the prognosis of the case. Babies with critical congenital heart disease need surgery or specific treatment within the first year of life or sometimes several years.  Without optimal treatment, critical cardiac defects can cause serious complications and death. Some new-borns with cardiac malformations stabilize after birth for a period of time.  When the family does not agree with the surgery, only palliative care (“comfort care”) is provided – thermal comfort, hemodynamic stabilization, pain therapy, minimally invasive respiratory support. Sometimes, the child is unstable or the indication of cardiac surgery is not required because the prognosis is unfavourable, and then the only ones to be considered are palliative care.

Keywords: cardiac abnormalities, palliative care, pregnancy

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