In counseling the patient with a fetus with CHD, attempts should be made to determine the exact cardiac diagnosis and whether there are associated extracardiac or chromosomal abnormalities. A careful family history and examination of appropriate family members may lead to the diagnosis of a genetic syndrome. An evaluation of the maternal medical and obstetric history will explore the possibility of maternal disease states, teratogens, or environmental exposures as cause for the cardiac lesion. The information obtained from a prenatal evaluation may lead to a possible cause of CHD in the fetus and thus more accurate counseling regarding recurrence risks and the prognosis for the present pregnancy. With further improvement in the prenatal diagnosis of structural cardiac disease, a knowledge of possible causes is essential for the clinician providing counseling. In addition, a multidisciplinary approach with the involvement of obstetricians, neonatologists, pediatric cardiologists, cardiac surgeons, and geneticists will optimize care in pregnancies complicated by a fetus with structural heart disease.
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