Pregnancy and delivery management in women with congenital heart defects in the fetus: challenges and contemporary approaches

Congenital heart defects are the most prevalent developmental anomalies in children and remain a leading cause of infant mortality. According to various sources, the prevalence of congenital heart defects in children varies widely, ranging from 4 to 50 cases per 1000 live births. Given the relative rarity of severe congenital heart defects and the historical lack of interdisciplinary collaboration in this area, research on perinatal cardiac care has often been limited to small case series or single-center studies. The aim of this review is to analyze recent literature on advancements in the perinatal and postnatal management of fetuses and newborns with congenital heart defects, including novel approaches to prenatal diagnosis, antenatal, intrapartum, and neonatal care, as well as to provide recommendations for enhancing accessibility of specialized care and outlining future research directions. A systematic search for publications was conducted using the following keywords and their combinations in both Russian and English: врождённые пороки сердца / congenital heart defects, ВПС/CHD, фетальная кардиология / fetal cardiology, внутриутробная визуализация / intrauterine imaging, фетальная хирургия / fetal surgery. Rapid advancements in fetal cardiac diagnostics, perinatal maternal–fetal monitoring, and in utero surgical interventions have significantly impacted pregnancy outcomes and neonatal prognosis in mother–newborn dyads affected by congenital heart defects. Early fetal echocardiography and routine obstetric screening have enhanced the early detection of pregnancies complicated by congenital heart defects. Novel approaches to prenatal counseling are being explored, and standardized algorithms are being developed to optimize fetal cardiac care, ensuring multidisciplinary perinatal support for families and labor management.