What to Expect During a Fetal Heart Evaluation: A Guide for Parents

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Getting an ultrasound scan of a baby can be an exciting or anxious time for expectant parents. It may be their first glimpse at their new baby, and it can also detect issues like heart conditions.

Ultrasounds are also called sonograms or anatomy scans, and they use sound waves to capture moving images of the baby in the uterus to monitor its health and development. Mothers typically have an ultrasound scan at 12 weeks to confirm pregnancy and specific “age” of the fetus, and then again six weeks later.

“Most of the time, obstetricians do a screening ultrasound around 18 to 20 weeks to look at the brain, lungs, heart, abdomen, and long bones and to estimate weight,” said Dr. Timothy Cordes, a pediatric cardiologist at Riley Children’s Health. “If they notice something doesn’t look quite right in their screening ultrasound, the doctor will refer the parents for a cardiac fetal echocardiogram.”

Fetal echocardiogram vs. ultrasound

An ultrasound and a fetal echocardiogram use the same technology to evaluate a baby’s heart in different ways. A fetal echocardiogram is more focused on the heart, allowing a pediatric cardiologist to view the structure and function of the heart, including its chambers, valves, arteries, and blood vessels.

“Fetal echocardiograms are also performed by either a pediatric cardiologist or, more often, a pediatric echocardiogram technologist who has special training in evaluating the heart, its arteries, and vessels,” Dr. Cordes said.

What are the reasons to have a fetal echocardiogram?

Sometimes, a fetal echocardiogram is routine, even if there’s no known issue with the baby’s heart. A mom will undergo an echocardiogram if there’s an immediate family history of congenital heart defects or other heart issues, diabetes or a maternal health concern that may affect a baby’s heart, like certain medications or chronic diseases.

If the baby’s heart appears to have an abnormality in the routine ultrasound, an echocardiogram will help the doctors better understand what’s happening. This heart-specific scan can detect issues like:

  • Major structure abnormalities causing one or more heart chambers to not develop properly, or less serious abnormalities such as a hole between chambers.
  • Transposition of the great arteries, where the two main arteries to the heart are switched.
  • An abnormal blood vessel.
  • An underdeveloped side of the heart.

While an abnormal finding in a fetal echocardiogram can be worrisome, it’s possible that the issue may simply require observation as the baby continues to develop.

“A baby’s heart continues to evolve throughout the pregnancy. You might have a hint of an issue at 18 to 20 weeks, but at 24 to 28 weeks, we can see much more detail and we can be more certain about what we’re seeing,” Dr. Cordes said. “The echo may give us some reason to be concerned about baby’s heart growth, but we might ask you to come back in four weeks and see how it’s evolved.”

Fetal echocardiogram: What to expect

For mom, the fetal echocardiogram will feel very similar to the ultrasound. An echo tech will place gel on the pregnant belly to capture sound waves using a wand (called a transducer) moving back and forth to gather pictures of the heart. Mothers do not need to fast or have a full bladder before the test.

If the cardiologist is administering the fetal echo, they will discuss the results with you. Otherwise, a cardiac echo tech will complete the test, and then the cardiologist will come in to discuss the results.

“An echocardiogram gives us the information right away, whether we think it looks good or if we have a concern to follow up,” Dr. Cordes said.

Most of the time, babies can tolerate whatever heart abnormalities are discovered before they’re born without needing an intervention, says Dr. Cordes. But if the heart issue changes how the delivery is managed, the doctor will discuss that with the parents ahead of time.

“We hold care conferences to discuss these issues with our maternal-fetal medicine doctors and neonatologists so we can fully answer the family’s questions and make sure everyone understands the plan at the time of delivery,” he said.

If the mom had a congenital heart problem in her childhood, Riley Children’s offers an Adult Congenital Heart Disease obstetrics clinic to talk about her pregnancy and discuss risks and how to manage them.

Related Doctor

Timothy M. Cordes, MD

Timothy M. Cordes, MD

Pediatric Cardiology

Anne G. Farrell, MD

Anne G. Farrell, MD

Pediatric Cardiology