What is fetal echocardiography?

Fetal echocardiography is a non-invasive, painless procedure used to evaluate fetal cardiac anatomy and detect congenital heart defects. A cardiologist will perform the procedure on an unborn child by placing a small sensor on mother’s abdomen, allowing the doctor to view their heart.

This is a specialized ultrasound test performed during pregnancy – to evaluate the position, size, structure, function and rhythm of the unborn baby's heart. Routine Ultrasound tests in pregnancy include scans such as a TIFFA scan, Anomaly Scan & a Growth Scan that are carried out at different times during pregnancy. A TIFFA scan usually gives the complete information about the fetus but there may be a limited view of the baby heart during a routine pregnancy ultrasound. A fetal echocardiogram may be requested if there is a need of additional information. The scan is usually done by Paediatric Cardiologists or by Fetal Medicine Specialists.

Fetal echocardiography is most often done during the second trimester of pregnancy— usually recommended between 18 to 22 weeks of pregnancy & is usually advised if other tests are indicative of some heart issue that may require evaluation. A repeat scan may sometimes be required if the initial scan shows some anomaly or if the information in the initial scan is inadequate.

The image quality is influenced by a number of factors like –

  • Gestation of pregnancy (in early pregnancy the heart is too small to be visualised well)
  • Fetal position (since the heart is at the front of the chest, the heart will not be seen well if the fetus is lying face down – or what is termed as a ‘spine anterior’ position)
  • Maternal factors like extreme obesity & excess amniotic fluid

Fetal echo can help find heart defects before birth. This is an advantage as a heart problem can be found early, the more likely treatment will work. This is because:

  • The family is well aware of the underlying condition
  • The cardiologist, the Obstetrician & the Neonatologist all are involved in the counselling & decision about Delivery & further post-natal care 
    Healthcare providers can get ready for problems that may happen during labour and delivery
  • The Delivery can be scheduled (timing / mode & place of delivery) to optimise safety both for the mother & the baby & also ensure a good postnatal outcome
  • Once the baby is born & diagnosis confirmed, appropriate treatment / management may be started. This might be medicine or surgery. The baby may be shifted to a Cardiac Centre, if required. Most babies will need routine neonatal care & a regular follow up with the Cardiologist. Rarely, some new born babies with critical heart disease may need some special medicines & appropriate treatment (medicines / surgery/ intervention) at a Cardiac Centre  

When is a fetal echo done?

A fetal echo is recommended in the following cases:

  • Heart Disease in a previous child in the family
  • Family history of genetic heart problems
  • Abnormal test results from other tests like ante natal (TIFFA) scan showing extra cardiac anomalies
  • Significant Fetal Growth restriction or abnormal fetal heart rate patterns
  • Genetic issues identified in the fetus – either by amniocentesis (invasive test for examination of the amniotic fluid) or other tests like double marker / NIPT test
  • Advanced maternal or paternal age
  • Fetus conceived by assisted reproductive technology
  • Maternal medications that may cause congenital heart defects. These include certain medicines for seizures, depression, and acne. They also include nonsteroidal anti-inflammatory medicines (NSAIDs) and blood pressure medicines (ACE-inhibitors).
  • Maternal health problems such as diabetes, lupus, or phenylketonuria
  • Maternal infections during pregnancy. These include German measles (rubella) or cytomegalovirus.
  • Antenatal scan showing evidence of too fast, slow, or irregular heart beats on exam.

What happens during a fetal echo?

A specially trained paediatric cardiologist, maternal-fetal medicine specialist, obstetrician, or radiologist does fetal echo. In general, the steps include:

  • You will lie on an exam table. You won’t likely need to change your clothes.
  • The provider will put gel on your belly
  • The provider will use an electronic device called a transducer that sends out sound waves.
  • He or she will move the transducer around to get the best images of the fetal heart. You may feel pressure as the transducer moves over your belly

Once the exam is complete, the gel is wiped off.

How safe is a fetal echo for the baby?

Fetal echo is an absolutely safe non-invasive painless ultrasound test for the baby’s heart that relies on sound waves to evaluate the baby's heart for problems before birth. This test is like a regular pregnancy ultrasound scan test & can be repeated during pregnancy with no risk of radiation to the unborn baby’s heart.

What happens after a fetal echo scan?

Once the scan is carried out, a report is issued & discussed with the obstetrician & the family will be counselled accordingly. If a heart anomaly is detected, the counselling involves a team of doctors including the primary Obstetrician, the Cardiologist & the Neonatologist (new born specialist), so that delivery & post-natal care can be planned at an appropriate time (in terms of pregnancy) & place (whether the baby is likely to need specialised NICU care or can be managed as a routine case).

Does a fetal echo require a follow up scan?

Usually this is a onetime test to screen the heart, however a repeat scan may be required if the initial scan detects some abnormality or sometimes even if the image quality is inadequate. This repeat scan may be scheduled usually 4 weeks (1 month) after the initial scan. Whenever a heart disorder is detected during a fetal echo, it is mandatory to do a post natal scan after delivery to confirm findings & to plan further management. 

Dr. Nitin Rao

For Appointments, Contact: 040 - 4477 7700