From the Fetal Therapy Program at OHSU Doernbecher Children’s Hospital
The risk of congenital heart disease risk is low, but not infinitesimal—one in 100 babies have a heart defect present before birth. While standard prenatal ultrasound can reveal cardiac abnormalities, the basic views of the heart in this screening may also fail to show congenital or structural defects or arrhythmias.
Why fetal echocardiography?
Fetal echocardiography is more sensitive in diagnosing cardiac defects than prenatal ultrasound. This advanced form of screening should be done for fetuses with a higher-than-usual risk of congenital heart disease. Optimal imaging is performed by a pediatric echocardiographer with expertise in fetal imaging, usually between 18-24 weeks. The majority of serious cardiac defects can be identified during this time, though earlier imaging is sometimes indicated for high-risk fetuses.
Indications for fetal echocardiography
Fetal echocardiography is appropriate in the setting of a family history of CHD in a first-degree relative, maternal use of certain medications (ACE inhibitors, retinoic acid and NSAIDS), maternal phenylketonuria or rubella, diabetes mellitus, twins or in vitro fertilization.
Clinical suspicion is another important indication for fetal echo. Concerns about a potential cardiac abnormality or the presence of other extracardiovascular abnormalities (including increased nuchal thickness) found by a primary care provider or OB-GYN warrant a closer look. Examination by a specialist in fetal echocardiography can reveal the cardiac structures in much greater detail than ultrasound. Fetal echo can help reassure parents and provide important information for delivery.
The table gives the major indications for a fetal echocardiogram at a glance.
Reasons for fetal echocardiography referral
Does prenatal diagnosis make a difference?
- Family history of congenital heart disease in first-degree relative
- Certain maternal medications—ACE inhibitors, retinoid acid, NSAIDS in the third trimester
- Maternal phenylketonuria
- Maternal rubella
- Maternal diabetes mellitus—before pregnancy or diagnosed in the first trimester
- Monochorionic twins
- Pregnancy conceived by IVF
- Suspicion of cardiac abnormality
- Presence of other systemic abnormalities
- Increased nuchal thickness
- Fetal hydrops
Numerous studies have consistently demonstrated that prenatal diagnosis improves the outcomes for the affected baby. When a cardiac diagnosis is made before birth, those babies have shorter delays from diagnosis to treatment, less multi-organ failure, fewer neurologic events and less pre- and postoperative mortality. Additionally, because of these improved outcomes, prenatal diagnosis has been shown to reduce health care costs significantly.
Ultrasound screening: is it enough?
Based on surgical numbers from OHSU Doernbecher Children’s Hospital, it is estimated that only about 50 percent of congenital heart defects are diagnosed prenatally. This is partly because routine fetal ultrasound requires only three views of the heart to look for signs of congenital heart disease. Studies in the United States and elsewhere show that ultrasonographers trained to perform six views of the fetal heart have a significantly higher ability to detect congenital heart disease. Missed abnormalities typically appear on those non-standard views.
Faculty from the OHSU Doernbecher Fetal Therapy Program offer CME lectures in the community and provide guidance on more detailed imaging techniques.
Benefits of a multi-disciplinary fetal therapy clinic
The OHSU Doernbecher Fetal Therapy Program is the only place in Oregon that brings together maternal-fetal, neonatal and pediatric specialists to plan a coordinated approach for fetal diagnoses after birth. Through OHSU Doernbecher, you and your patients have access to a full range of pediatric subspecialists, including experts from cardiology, urology, surgery, neonatology and more.
We coordinate care for the family’s convenience and comfort. In the fetal therapy clinic, parents consult with their customized multi-specialty team, receive a plan for prenatal monitoring and delivery and have all follow-up appointments coordinated. We present the team’s ideas to the family and referring providers, including diagnostic details, treatment options, what to expect and plans for postnatal pediatric care.
Your partner for fetal screening
Experts recommend fetal echocardiography for patients who are pregnant and have a family history of congenital heart disease or other indications above. If you have concerns about a patient with or without these indications, we encourage you to contact us with questions.
The Fetal Therapy Program at OHSU Doernbecher Children’s Hospital is always available to provide consultation, screening expertise and assistance in planning delivery and neonatal care. Our experienced providers and specialized care coordinator are here to help you meet your patients’ needs.
To refer a patient or consult with our team, call the OHSU Physician Consult & Referral Service at 888 346-0644.
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