The Fetal Cardiac Care Pathway: Organization, Standards, and Clinical Practice: A Narrative Review and Organizational Perspective for the Italian Context

Congenital heart disease (CHD) is increasingly diagnosed before birth, but the benefit of prenatal diagnosis depends on the care pathway that follows detection. This narrative review traces fetal cardiac care from obstetric screening to neonatal stabilization and follow-up and proposes an organizational framework adapted to the Italian healthcare context. International guidelines, consensus statements, cohort studies, organizational surveys, and quality-improvement studies were interpreted alongside the experience of a fetal cardiology center in Rome. Published evidence supports structured pathways based on hub-and-spoke referral, a multidisciplinary Fetal Heart Team, lesion-specific surveillance, physiology-based Level of Care (LOC) stratification, and standardized delivery planning. A multi-institutional implementation study has associated standardized delivery planning with higher rates of vaginal delivery and delivery at ≥39 weeks. The Italian perinatal system presents specific challenges, including numerous birth centers, separation between delivery hospitals and cardiac surgical centers, and variable neonatal resuscitation readiness. Proposed adaptations include mapping LOC categories onto Italian Level-I and Level-II birth centers, telemedicine-supported regional networks, a dedicated cardiac care coordinator, minimum monitoring and simulation-training requirements, a three-tier model of parental psychological support, and a national outcome registry. These organizational hypotheses require prospective evaluation in multicenter Italian settings.