Management of severe distress in a potentially anomalous preterm fetus

Unless there is unequivocal evidence of a congenital anomaly incompatible with life, expeditious delivery should be offered to the patient whose potentially viable fetus is showing evidence of severe distress. The patient should be informed of the difficulties in interpreting diagnostic testing as well as both the immediate risks and future implications of vertical cesarean delivery. Our case further suggests that ultrasonographically and echocardiographically detected congestive heart failure may actually help confirm the diagnosis of fetal distress rather than necessarily identify an anatomic cardiac anomaly.