Pediatric Cardiology

The Perinatal Cardiology Unit at Shaare Zedek Medical Center is directed towards pregnant women at increased risk of fetal heart problems, including:

• Women with congenital heart defects, women who have previously given birth to a child with a congenital heart defect, or those with family members with congenital heart issues.
• Women who, during prenatal monitoring, had suspected fetal heart defects or irregular heart rhythms.
• Women with medical conditions that elevate the risk of fetal heart problems, such as diabetes, infectious diseases, phenylketonuria, and autoimmune diseases.
• Women taking certain medications known to increase the risk of fetal heart defects or those exposed to alcohol or smoking during pregnancy.
• Multiple pregnancies, especially identical twin pregnancies sharing a placenta.
• Women in whom routine ultrasound revealed abnormal findings in other organs, prompting further evaluation of cardiac involvement, such as kidney abnormalities, brain abnormalities, bowel obstruction, brain cysts, kidney dilation, single umbilical artery, skeletal abnormalities, and more.
• Women with abnormal neck transparency or abnormal findings in the nuchal translucency, fetal nasal bone, or other genetic tests.

If there is a suspicion of a complex heart defect, the option for referral to the multidisciplinary Pre-birth Diagnosis Clinic will be offered, which includes a team of various experts, including pediatric cardiologists. Additionally, the unit's team works closely with the hospital's women's physicians and consults various obstetric units, including delivery rooms, high-risk pregnancy unit, and the women's department.

During the visit to the clinic, a fetal echocardiogram will be performed to confirm or rule out any fetal heart defects. After the examination, parents will receive counseling regarding the implications of the heart defect and its consequences, as well as recommendations for further follow-up or treatment.

Concurrently, the unit operates a support system for parents dealing with the diagnosis of a significant fetal heart defect. The support system includes not only the unit's doctors but also parents of children with congenital heart defects who understand the concerns and challenges and are available to share their personal experiences throughout the diagnosis and treatment journey.

Pregnant women diagnosed with complex heart defects will be invited for regular follow-up meetings, on average once a month until delivery. The team will arrange a meeting between the parents and the pediatric cardiothoracic surgeon who will be responsible for treating the newborn. Additionally, parents will meet with genetics specialists, social workers, and pediatricians as needed. Prior to delivery, the unit's team, in collaboration with the hospital's obstetricians and pediatricians, will develop a birth plan and provide initial care for the baby. Thanks to this close collaboration, in most cases, babies with heart defects can be born at Shaare Zedek. The unit's doctors are available at all times to provide immediate care for any newborn in need, both during delivery and throughout the postpartum hospital stay.

A fetal echocardiogram is a non-invasive ultrasound examination specifically designed to visualize the fetal heart. The test takes approximately 20-60 minutes. It is completely safe for both the mother and the fetus. The examination can be performed starting from the 16th week of pregnancy, although greater accuracy is achieved from week 20 onwards.

Thanks to this examination, some heart conditions in the fetus can be treated even during the pregnancy stage, and it also allows for planning the delivery and postnatal care in advance. The test enables the detection of most significant heart defects that may require immediate attention after birth. Early diagnosis and proactive planning can help prevent mortality and illness.

Examples of therapeutic treatment for the mother:

- When the fetus has rhythm disturbances or heart failure. This option may require the mother's hospitalization for monitoring until the appropriate dosage is found to treat the fetus without harming the mother.
- Premature delivery to provide direct care for the infant.
- Birth planning - determining the location, mode of delivery, and postnatal care.

Treatment for the newborn begins with a fetal echocardiogram. Based on the precise diagnosis after birth, a personalized treatment plan, including medical therapy, is tailored for the newborn.