Indications for Fetal Echocardiography: A provider may recommend this test if:

Maternal Factors: Diabetes (pre-gestational or early gestational), autoimmune diseases (e.g., lupus), or certain infections (e.g., rubella).

• Pre-Gestational Diabetes
• Anti-Ro/La Antibodies
• Maternal CHD
• Infections

Medication/Teratogen Exposure: Use of specific medications (e.g., for epilepsy), drugs, or alcohol during pregnancy.

Fetal Concerns: Abnormal routine scan suggesting potential cardiac issue 1. Abnormal 4-Chamber/Outflow View

• Abnormal 4-Chamber/Outflow View
• Increased NT (>3.5mm)
• Arrhythmia
• Hydrops
• Situs Anomalies
• Monochorionic Twins/TTTS
• IUGR With Doppler Changes

Assisted Reproduction: IVF pregnancy

Extracradic anomaly on antenatal scan

• CNS
• Omphalocele
• Congenital diaphragmatic hernia (CDH)
• Renal, Skeletal malformation
• Congenital pulmonary alveolar malformation (CPAM)
• Placental Tumor
• Polyhydramnios/ fetal Hydrop

Genetic / Family Indications

• Previous Child With CHD
• Parental CHD
• Aneuploidy (T21/18/13), 22q11 Deletion, Pathogenic Single-Gene Variants, Abnormal Cf-DNA Findings

Parental request for reassurance → Consider after counseling.

Procedure and Technique

• Method: Similar to a routine pregnancy ultrasound, a transducer is moved over the mother's abdomen using gel, using sound waves to create moving images of the heart.
• Timing: Optimal imaging usually occurs between 18 and 24 weeks of pregnancy.
• Duration: The scan typically lasts 30 minutes to two hours.
• Personnel: Performed by a sonographer or fetal cardiologist and interpreted by a specialist in fetal heart disease.

Limitations and Risks

• No Known Risks: As it uses sound waves, it is considered safe for the fetus and mother.
• Limitations: While effective, some abnormalities like small holes, mild valve issues, coronary artery anomaly or coarctation of the aorta can be difficult to detect prenatally. Valve lesion severity may increase over time and needs follow up. Rhythm abnormality may happen any time and normal fetal echocardiography does not rule out potential chance of arrhythmia.

Benefits

• Allows specialized teams to plan for delivery, potentially requiring a hospital with a specialized neonatal cardiac unit.
• Helps improve outcomes for babies with severe complex congenital heart disease by enabling early intervention.