How is the test performed? |
The test is done by the specialist in a manner similar to a routine fetal sonogram. It is painless and takes about 30 minutes. After the test, parents are fully informed of the results and questions are answered.
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What conditions can be identified? |
| Structural abnormalities known as congenital heart disease (CHD), cardiac rhythm disturbances (or arrhythmias), and disorders of cardiac function |
Who needs a detailed fetal echocardiogram? |
Reasons for considering this test include:
A. Fetal Reasons: |
| 1 |
Recognition of other birth defects or known chromosomal or genetic abnormalities or an abnormal amniocentesis. |
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Presence of polyhydramnios: 10% have structural fetal anomalies with one of the most common being cardiac. |
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Presence of fetal hydrops: the abnormal accumulation of fluid in two or more cavities (abdomen, lungs, heart) often causes, or is caused by, heart failure. |
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Fetal arrhythmias: bradycardia (slow heart rate) is associated with heart disease. 50% of those having complete heart block have structural anomalies. Tachycardia (fast heart rate) may result in poor heart function. Skipped beats are typically innocent and can be identified by fetal echocardiography. |
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| B. Maternal Reasons: |
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Diabetes mellitus has a cardiac defect rate as high as 5%. This excludes late gestational diabetes which does not have an additional risk of heart disease. |
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Maternal auto antibodies (lupus type) are associated with fetal bradycardia and varying degrees of heart block. In the setting of a previously affected fetus, the recurrence risk is 20%. |
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Maternal medication exposure: Vitamin A analogues Isoretinoin (topical preparations are not a risk), anti-seizure medications, alcohol, tobacco and lithium are all potential cardiac teratogens. A teratogen is anything that causes abnormal development of fetal structures. |
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Maternal congenital heart disease: Mothers who have significant CHD have a 5-10% incidence of having a child with a CHD. |
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In vitro fertilization is associated with an increased risk for CHD. |
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| C. Family History Reasons: |
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Families with a sibling or the father with CHD have a 2% risk of recurrence with subsequent pregnancies, although there may be some variation with certain lesions. |
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If a sibling has a cardiac abnormality related to a genetic syndrome, then the recurrence risk is equal to that of the syndrome. |
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When can a fetal echocardiogram be performed? |
| Details of heart structure cannot be seen until 18 weeks gestation using imaging through the surface of the abdomen. Sometimes, repeat examinations are needed. |
Are there limitations of fetal echocardiography? |
| Some heart abnormalities are not detectable prenatally even with a detailed expert examination. These tend to be minor defects, such as small holes in the heart, or mild valve abnormalities. In addition, some serious cardiac defects do not become evident until after birth. The fetal echocardiogram focuses on the heart. The fetal echocardiographer may not see defects in other parts of the fetus. |
What are the implications of fetal echocardiography? |
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The detection of a heart defect increases the risk of finding other malformations in the child. A detailed ultrasound of the rest of the fetus is necessary. Also, amniocentesis to test the chromosomes may be recommended. |
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A serious or even lifethreatening heart abnormality may be identified. It may have a significant impact on the future of the child. You will want to discuss this with your doctors. |
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Cardiac rhythm disturbances often need to be treated before birth. Defects of cardiac structure are usually treated after the birth. |
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In most cases of CHD diagnosed prenatally, delivery may proceed as planned in the birthing center of choice. In some cases it is safest to deliver the pregnancy at, or near, the center at which postnatal treatment will take place. This is especially true if surgery will be required soon after birth. Who can counsel or advise me about cardiac findings? |
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A obstetrician or perinatalogist can advise you about the management of your pregnancy. |
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A pediatric cardiologist is in the best position to give advice about the outlook for your child’s heart problem. |
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A geneticist can provide information about a fetus with an associated genetic syndrome, if present, and advise about future pregnancies. |
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A cardiac surgeon can give details about surgical procedures that may be needed. |
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What is the impact of fetal echocardiography?
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| Fetal echocardiogram has had a tremendous impact with improved accurate diagnosis and appropriate counseling for families. It aids in the management prenatally and guides the timing, location, and route of delivery. The prenatal accurate diagnosis will improve the outcome of some fetuses with severe cardiac malformations. Fetal echo is beginning to identify candidates for fetal cardiac intervention and guide these procedures. |
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