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Fetal Cardiology
Fetal Heart Ultrasound
Fetal heart abnormalities are among the most typical forms of abnormality detected before birth. Just under 1 in 100 babies have heart problems (Congenital Heart Disease). Many of these problems are isolated to the heart; however, some are part of more complex fetal abnormalities or syndromes involving other organ systems.
Fetal heart screening is part of the Mid Trimester Ultrasound examination that most women have at 19-20 weeks of gestation. It aims to identify that the heart is in a normal position and has 4 normal-sized chambers, normal heart valves and large arteries arising from the heart. A typical screening heart ultrasound examination rules out the majority of complex Congenital Heart Disease abnormalities.
Fetal Echocardiography
Fetal Echocardiography is a focused ultrasound examination of the fetal heart when an abnormality is suspected on screening or if a pregnancy is at a higher-than-normal risk of fetal heart abnormality. Fetal Echocardiography is performed by a Fetal Cardiologist (Children’s Heart Specialist) or Obstetric Ultrasound Specialist. A detailed Fetal Echocardiogram can identify standard heart structure and function from early in the second trimester (approximately 14 weeks of pregnancy). It differs from a screening ultrasound in that it aims to identify the structure and function of the heart chambers and valves, all of the artery and vein connections to and from the heart, and their relationships within the fetal chest. It also looks at the functioning of fetal-placental circulation. A Fetal Echocardiogram takes 30-40 minutes, depending on fetal position and the complexity of any abnormalities identified. A Fetal Cardiologist can immediately give the scan results and help the family plan further management throughout the pregnancy and after delivery as required.
Why is Fetal Echocardiography important?
Fetal Cardiology is a growing area of Cardiology practice. Identifying Congenital Heart Disease before birth gives the best chance of survival for specific abnormalities. It allows planning for delivery in a centre capable of managing babies with complex heart disease. Diagnosis early in pregnancy gives families choice and time to prepare for a very different start to life with their child, who, in some cases, may need early medical or surgical intervention.
Reasons for Fetal Echocardiography
Not every fetus requires Fetal Echocardiography. For low risk pregnancies with a normal screening Mid Trimester Ultrasound examination no further testing is required.
Reasons for which a focused Fetal Echocardiogramis performed include:
- Suspected Congenital Heart Disease on screening Ultrasound examination
- Family history of Congenital Heart Disease,Chromosomal
- Abnormalities or Cardiomyopathy in a first degree relative
- Fetal Chromosomal Abnormalities including Downsyndrome (Trisomy 21), Trisomy 13 and 18, and Turner syndrome
- Fetal Malformations outside the heart (kidney, lung,gut and brain)
- Increased Nuchal Translucency on first trimester screening
- Maternal Metabolic Disorders including Diabetes Mellitus and Phenylketonuria
- Fetal Arrhythmias (abnormal fetal heart rhythm)
- Monochorionic (identical) Twin pregnancies
- Maternal exposure to certain medications or viruses during pregnancy
- Fetal Hydrops (accumulation of fluid within the fetal body cavities)
Multidisciplinary Care
Congenital Heart Disease is often associated with abnormalities outside the heart, or part of a larger Chromosomal or Syndromic abnormality affecting the whole baby. Women whose fetuses are identified to have significant Congenital Heart Disease will potentially need to see multiple specialists during the pregnancy and beyond. At Siles Health we have a Genetic Counsellor who can help support and guide families through this difficult time with the assistance of the Fetal Cardiologist and other sub-specialties if required.