Redundant foramen ovale (RFO) is defined as an abnormally redundant foramen ovale flap that extends at least halfway across the left atrium. The exact pathogenesis is unknown. Premature, isolated, in utero RFO is rare. The prevalence in general population is unknown as it may be easily ignored on routine fetal echocardiography. The reported frequency in fetuses referred for echocardiographic examination is 0.6-1.7%. It can cause right ventricular volume overload leading to fetal hydrops and subsequent cardiac failure. In such cases, prompt delivery depending on fetal gestational age may be instrumental for the survival of the neonate. 67% can develop cardiac arrhythmias which generally resolves at birth. The most common is premature atrial contractions though rarely, supraventricular tachycardia can also occur. RFO usually occurs in isolation but when associated with congenital heart disease, it carries a poor prognosis. Several series have reported redundant foramen ovale in echocardiographic and autopsy findings in children and adults but only few reports on the antenatal detection of isolated RFO has been described. We discuss two prenatal cases of isolated redundant foramen ovale diagnosed in the third trimester. They were followed up two weekly without development of any complications and delivered at term. After delivery, the infants had no history or symptoms of cardiac distress. Echocardiography showed a structurally normal heart. Hence, if there are no associated anomalies in a case of redundant foramen ovale, the prenatal management need not be altered.

The primary objective of the study was to present a 5-year data on the outcomes after prenatal diagnosis of CHD. This is a retrospective descriptive study, conducted in the fetal medicine unit of an academic tertiary care referral centre in South India. The details of all cases with a prenatal diagnosis of fetal cardiac lesions from January 2012 through December 2016 were collected. All cases were systematically analyzed for type of lesion, associated malformations, chromosomal abnormalities, prognosis of the lesion, the decision taken by the couples and the information regarding post natal outcome, wherever available. Prenatally diagnosed fetal cardiac lesions were identified in 310 cases. In 220 (76.1%) cases, the couple opted for termination of pregnancy. In this group, 52% of them had an isolated cardiac defect with good prognosis. In the rest of the 69 cases who decided to continue, 7 cases had an IUD. In the 62 cases that culminated in a live birth, 46 cases opted for postnatal cardiac care. Corrective surgery was attempted in 18 neonates with 2 resulting in neonatal death. Prenatal diagnosis of isolated CHD provides an opportunity for an improved immediate neonatal outcome. A thorough evaluation for extracardiac and genetic abnormality will facilitate better utilization of health care resources by triaging patients with isolated CHD having good prognosis for targeted postnatal care. Also, antenatal pediatric cardiology counselling will enable the couple to make decisions regarding postnatal management options.

Diagnostic prenatal invasive testing currently forms an integral and extremely significant component of the practice of obstetric care and has a twofold purpose. The primary aim is to offer management options and informed decision making to pregnant women and their companions. The secondary aim is to ensure that every fetus has an optimal outcome. Currently, most professional societies offer guidelines on prenatal invasive testing based on specific indications. Society of Fetal Medicine (SFM) clinical practice recommendations are developed for use by all practitioners of fetal and maternal healthcare. They are intended to facilitate a reasonable standard of care by the entire medical community. Practitioners are encouraged to go beyond these standards in relevant clinical situations. This document has been drafted after extensive inputs and discussions by practitioners and experts, followed by a consensus.