A fetal echocardiogram is a detailed ultrasound of the fetal heart which involves sound waves to identify structural or heart rhythm issues that require evaluation and treatment.
The initial fetal echocardiogram is usually performed between 18-22 weeks gestation and can be repeated as needed throughout the pregnancy. The initial study is usually between 45 minutes to 1.5 hours depending on the complexity. Multiple gestation pregnancies (twins or triplets) usually require 1 hour per fetus.
A pediatric cardiologist with expertise in fetal echocardiography will consult with you after the fetal echocardiogram and explain the results in detail as well as answer any questions.
We typically follow fetuses with heart disease throughout the pregnancy at regular intervals. As needed, consultations will be arranged for you with any additional subspecialties such as neonatology, pediatric cardiothoracic surgery, pediatric interventional cardiology and genetics.
We will help you to transfer care to our institution if the fetal heart disease requires additional monitoring or intervention after delivery.
What is a fetal echocardiogram?
A fetal echocardiogram is an ultrasound evaluation of a fetal heart. The exam uses sound waves which ‘echo’ off the fetal heart structures and create a picture or echocardiogram of the heart. This provides information about how the heart is formed and if it is working properly.
All fetal exams will be performed in our dedicated, state-of-the-art fetal echocardiography suite at our main hospital. The fetal echocardiography suite is private and separated from the general pediatric cardiology office. Abdominal ultrasound is the most common form of ultrasound to evaluate the baby's heart. We apply gel to the mother's abdomen and the ultrasound probe is gently placed on the mother's abdomen to take pictures of the baby’s heart. This test is not painful and causes no harm to the baby. The test takes an average of 45–120 minutes depending on the complexity of the baby's heart.
The test is performed by a specially trained ultrasound technician and/or a physician and the images are interpreted by a pediatric cardiologist who specializes in fetal heart disease.
When are fetal echocardiograms performed?
Fetal echocardiograms can reliably be performed any time after 17–18 weeks gestation. If scanning is done before 18 weeks, you may be asked to return for more definitive pictures to confirm the findings on the early study. In some cases 18 weeks is still too early to evaluate the heart in detail.
Is there any preparation needed for the test?
A full bladder is not necessary for a fetal echocardiogram.
It is important to know why you were referred by your obstetrician (difficulty visualizing the fetal heart, family history, medication exposure, suspected heart disease, abnormal genetic testing). This is especially helpful if the reason for referral is that you have a heart condition yourself.
If possible, it is helpful to bring another caregiver with you, who can look after any small children while you are undergoing the fetal echocardiogram.
When will I get answers?
The pediatric cardiologist will meet with you right after the study is completed and provide you with a detailed explanation of the results. The answers that are available will depend on your specific fetal echocardiogram including how many weeks pregnant you are, what is found on the study and quality of the pictures.
If the study is normal, you will not need further follow up unless there are new concerns during the pregnancy. Some patients are asked to have a repeat study before or after birth depending on the reason the study was performed in the first place and the clinical findings.
Some medical conditions (like Lupus) require several studies even if the first one is normal. There are also times that repeat fetal echocardiograms are recommended if there is a structure that is not seen clearly. In this case, you may be asked to return even though the suspicion of a problem is low.
Even in the case of a totally normal study, you will be counseled that not all heart problems can be ruled out prior to birth. This is because both the heart and circulation of a fetus are different than in a baby after birth. In addition, some fetal heart structures are too small to be seen before birth.
What if a heart defect is found?
When a heart defect is found, one of our pediatric cardiologists will explain the diagnosis as soon as the study is completed. The pediatric cardiologist will use pictures to explain the significance of the heart defect including any issues related to the pregnancy, delivery and potential need for heart surgery after birth.
In almost all cases you will be asked to return for follow up fetal echocardiograms to obtain more information as you prepare for delivery. Your pediatric cardiologist will give you as much information as possible and also inform you of what questions still remain. Your future visits may include meeting with a cardiac surgeon or interventional cardiologist to learn more about heart surgery or other procedures after birth.
The diagnosis of heart defect has significant implications for the overall health of the fetus as certain heart defects may increase the risk of genetic problems. These issues may have significant implications for the prognosis of the child and may play a role in helping you make decisions about your pregnancy. Your cardiologist will provide you with information about whether or not you need to be concerned about genetic problems. Our care team also includes physicians who specialize in High Risk Obstetrics (Maternal Fetal Medicine), Pediatric Genetics and Neonatology (Newborn Medicine). Our Fetal Care Center team will meet with you and arrange for a tour of the Neonatal Intensive Care Unit (NICU) to help prepare you for the delivery and newborn period.