Fetal Echocardiogram: What to Expect?

If you are expecting a baby and a doctor has recommended a fetal echocardiogram, you may wonder what the procedure is about. We can look at the structure and function of the baby’s heart even before it is born with a fetal echocardiogram. It is typically performed between 18 and 24 weeks of pregnancy, during the second trimester of pregnancy.

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The fetal echo, like other echos, uses sound waves to create pictures of the baby’s heart in the womb. The procedure provides in-depth information about abnormalities in the baby’s heart, blood flow, or heartbeat, if any. Every year, 1% of births have congenital heart diseases (CHD), which have a wide range of heart issues, the most common being ventricular septal defects. Doctors use fetal echocardiography to check for congenital heart disease. 

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In this blog, we will explore fetal echocardiography, including its techniques, indications, and other relevant details.

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What is fetal echocardiography?

It is a diagnostic imaging test that uses sound waves to create images of the fetal heart, helping us evaluate the position, size, structure, function, and rhythm of the unborn baby’s heart. An echo for the obstetrician can provide a limited view of the baby’s heart during a pregnancy ultrasound. A fetal echocardiogram, on the other hand, provides a detailed evaluation by a specialist.

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Fetal echocardiography evaluates

• Blood flow pattern

• Heart anatomy, including chambers, valves, and vessels

• Heart rhythm and function

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It is done when there are concerns about the baby’s heart or when the pregnancy involves risk factors for congenital heart disease.

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Need for fetal echocardiography:-

Not all pregnant women require a fetal echo. For most women, a basic ultrasound is sufficient to show the development of the four chambers of the baby’s heart.

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Your gynaecologist may recommend it if they detect an abnormal heartbeat in the fetus.

It may be required if

• Your child carries the risk of having a heart abnormality or other disorder.

• There is a family history of heart disease.

• If another child of yours has a heart disease.

• Consumption of  drugs, alcohol, and unsafe medicines during pregnancy.

• You suffer from conditions like rubella, type I diabetes, lupus, or phenylketonuria.

• You are pregnant at an advanced age.

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It is always better to look for a cardiologist who specialises in paediatric medicine to review the results.

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Preparing for the test:

Like the routine prenatal ultrasound, a fetal echocardiogram does not require a full bladder. No special preparations are required for the test. Roughly, it takes around 30 to 45 minutes to complete the test. Rarely does it take two hours.

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Types of fetal echocardiography

It is like a usual sonography but when done on the abdomen it is called the abdominal echocardiography, when done through the vagina it is called the vagina echocardiography.

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Abdominal echocardiography

• It is performed on the abdomen. You need to lie down on the examination table and expose your belly.

• The ultrasound technician or sonographer applies jelly to allow the transducer to move without friction and to transmit these sound waves.

• A transducer is a handheld device that produces ultrasound waves and is moved across your belly. It sends and receives ultrasound waves through the skin.

• The sent waves echo as they hit a dense object, i.e, the unborn child’s heart. These waves are reflected into the computer, and images of the baby’s heart can be obtained.

• After the procedure, the jelly is wiped off the abdomen, and the procedure is complete.

• The test takes 45 to 120 minutes and is subject to the complexity of the fetal heart.

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Transvaginal echocardiography

• In this procedure, you are asked to undress from the waist down and lie on the examination table.

• A small probe is inserted into the vagina and sound wave produced create images of the baby’s heart.

• It is done in the early stages of pregnancy to provide clear images.

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The following techniques are used to get a detailed structure of the fetal heart:-

1. Two-dimensional echocardiography: it shows the actual structure and real-time motion of the structures of the heart

2. Doppler echocardiography helps identify issues associated with the heart valves that connect the four chambers of the heart.

3. Colour Doppler is another technique used to determine the direction of blood flow in the heart.

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What do the results show?

Your results may show the following possibilities.

• The test is normal: no heart problems are found, and your pregnancy care can continue as usual.

• When the test is abnormal, it indicates that the baby’s heart function and rhythm have issues.

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Sometimes, even with the normal result, heart problems go undetected as fetal circulation is different before birth. If a heart defect is detected, it can have a significant impact on the baby's overall health and future. You will then be required to make informed decisions about the pregnancy.

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You may still be required to undergo more testing. Other tests that may be required include:-

• Foetal ultrasound to monitor fetal growth, well-being, and assess the rest of the fetus for abnormalities in other organs.

• Cardiac MRI to assess the overall health of the fetus and identify potential problems with other organs.

• Aminocentesis to determine chromosomal and genetic disorders and congenital disabilities. It involves insertion of a needle through the abdominal and uterine wall into the amniotic sac to take a sample of amniotic fluid.

• Genetic counselling involves genetic counsellors assessing the likelihood of a genetic syndrome or abnormalities in other organs.

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Importance of the test

Fetal echocardiography can rule out cardiac conditions in the unborn, but often yields abnormal results that are inconclusive and require further testing.

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Once the condition is diagnosed, a pregnancy can be managed better, and you can be more prepared. It also helps guide you on the treatment plan your baby may need after birth, such as corrective surgery. It also prepares you to get support and counsel to help you make decisions.

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Risks associated with fetal echocardiography

No risks are associated with fetal echocardiograms, as they use ultrasound technology and are safe for both the mother and the child.

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Conclusion

Fetal echocardiography is used to assess congenital heart disease. Identifying potential issues early enables healthcare providers to provide the best possible care and outcomes. It also ensures that future parents are well-informed and prepared.