Learn about HOTV’s busy Fetal Cardiology Program
Our Fetal cardiology services include:
Frequently Asked Questions
Fetal echocardiography is a test using ultrasound (sound waves) to study the structure, function and rhythm of your baby’s heart before birth.
Your obstetrician may obtain a general view of your baby’s heart during a routine pregnancy ultrasound. However, a fetal echocardiogram is a very detailed evaluation of your baby’s heart by a specialist in fetal cardiology.
The test is done by the specialist in a manner similar to a routine fetal sonogram. It is painless and takes about 30 minutes. There are no known risks to the mother or the fetus however recent studies of possible subtle effects suggest that its use should not be frivolous. After the test, parents are fully informed of the results and questions are answered.
Structural abnormalities known as congenital heart dis-ease (CHD), cardiac rhythm disturbances (or arrhythmias), and disorders of cardiac function can be identified.
Reasons (indications) for considering this test include:
A. FETAL REASONS:
1. The recognition of other birth defects, chromosomal or genetic abnormalities, or an abnormal amniocentesis. 2. Presence of polyhydramnios: excessive amniotic fluid.
3. Presence of fetal hydrops: the abnormal accumulation of fluid in two or more body cavities (abdomen, lungs, heart).
4. Fetal arrhythmias: bradycardia (slow heart rate) is associated with structural anomalies of the heart. Tachycardia (fast heart rate) may result in poor heart function. Skipped beats are typically innocent. All can be identified by fetal echocardiography.
B. MATERNAL REASONS:
1. 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. 2. 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%. 3. Maternal medication exposure: Vitamin A analogues Isoretinoin (topical preparation are not a risk), anti-seizure medication, alcohol, tobacco, lithium and certain blood pressure medications are all potential cardiac teratogens. A teratogen is anything that causes abnormal development of fetal structures. 4. Maternal or paternal congenital heart disease: Either parent who has significant CHD have a 5% incidence of having a child with a CHD.
C. FAMILY HISTORY REASONS
1. 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. 2. If a sibling has a genetic syndrome associated with CHD then the recurrence risk depends on the risk of the recurrence of the syndrome.
This test can be performed at 17 weeks gestation or after. Sometimes repeat examinations are needed.
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. Because the fetal echocardiogram focuses on the heart, the fetal echocardiographer does not usually see defects in other parts of the fetus.
The implications of a heart defect increases the risk of find-ing other malformations in the child. A detailed ultrasound of the rest of the fetus is sometimes necessary and an amniocentesis to test the chromosomes may be recommended.
• A serious or even life threatening heart ab-normality may be identified. It may have a significant impact on the future of the baby. You will want to discuss this with your doctors.
• Cardiac rhythm disturbances often need to be treated before birth. Defects of cardiac structure are usually treated after the birth.
• In most cases of CHD diagnosed prenatally, delivery may proceed as planned in the birthing center of the parent’s choice. In some cases, especially true if surgery will be required soon after birth, it is safest to deliver the pregnancy at, or near, the center at which postnatal treatment will take place.
• An obstetrician or perinatologist can advise you about the management of your pregnancy.
• A pediatric cardiologist is in the best position to give advice about the outlook for your child’s heart problem.
• A geneticist can provide information about a fetus with an associated genetic syndrome, if present, and advise about future pregnancies.
• A cardiac surgeon can give details about any surgical procedures that may be needed.
Fetal echocardiography has had a tremendous impact with improved diagnosis and appropriate counseling for families. It aids in the management prenatally and guides the timing, location and route of delivery. The prenatal accu-rate diagnosis will improve the outcome of some fetuses with severe cardiac malformations. Fetal echocardiography is beginning to identify candidates for fetal cardiac intervention and guide these procedures.