**3. Pregnancy and delivery management**

Prenatal diagnosis has an impact on morbidity and mortality for most severe conditions because it allows an appropriate referral and planning of delivery and immediate assistance in expert centers resulting in improving short-term outcomes. However, its influence on long-term outcomes are still not clarified. In particular, prenatal diagnosis of conditions that constitute a neonatal emergency, such as duct dependent lesions, allows for manage the delivery in a tertiary care center. This strategy improves survival significantly and reduces preoperative morbidity and risk of neurological compromission [7]. CHD patients diagnosed postnatally that were born at non-tertiary centers, without specialist neonatal or cardiac services, presented later and required much higher levels of cardio-respiratory support during transfer from geographically distant locations [8]. Of note, clinical instability in postnatally diagnosed infants with CHD is an established risk factor for morbidity and mortality [8]. Moreover, it has also been proven that prenatally diagnosed infants undergo significantly earlier surgery [8].
