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The question as to where to deliver the baby arises whenever there is an antenatal diagnosis of significant fetal anomaly. The decision should in theory be made collaboratively between parents, fetal medicine specialists, neonatologists and relevant paediatric specialists (eg, cardiologists, surgeons, nephrologists); but the discussion, and the decision, can be distorted by a variety of factors. These include misperceptions of safety, based on anecdotes of unfortunate experiences; the desire of regional fetal medicine specialists to see the outcomes of their diagnoses; and real or imaginary doubts about the ability of a referring centre to undertake initial stabilisation of a neonate with a potentially complicated problem.
Patient safety is clearly a very important issue, but statements about safety should be based on hard data rather than anecdote or uninformed opinion. For this reason, the paper by Kelsall et al in this edition is a welcome addition to the literature on the safety of delivering babies with antenatally diagnosed cardiac anomalies at a site that, though remote from the cardiac surgical facility, nevertheless has high-quality diagnostic capability and a large neonatal intensive care unit. Essentially, they demonstrate that this practice is safe, though with a number of appropriate caveats – and readers might wonder what happens when their one neonatologist with advanced echocardiography skills is on holiday. These data will become even more important in the UK …
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