2 Who Should Have a Fetal Heart Scan
I. GENERAL INFORMATION AND BACKGROUND
B. Level II or specialized fetal anatomical ultrasound
1. Specialized ultrasound is performed when an anomaly is suspected on the basis of history or biochemical abnormalities or when the results of either the limited or standard scan suggest the presence of fetal pathology.
2. Specialized ultrasound is performed by obstetricians, perinatologists, radiologists, and sonographers who have additional expertise in obstetric ultrasound.
C. Fetal echocardiography
1. Two-dimensional and Doppler echocardiographic evaluation includes detailed assessment of the cardiac anatomy, blood flow, heart rate and rhythm, and heart function.
2. Fetal echo is performed in pregnancies at risk for or with suspected structural, functional, or rhythm-related fetal heart disease.
3. Responsible personnel include:
a. Pediatric cardiologists with expertise in fetal and pediatric echocardiography.
b. Obstetrics or radiology personnel with training in fetal echocardiography but with assistance from pediatric cardiologists for interpretation of the findings and prenatal counseling.
II. INDICATIONS
A Maternal indications
1. Maternal metabolic disorders.
a. Type 1 or 2 diabetes mellitus (preconception).
2. Maternal congenital (or familial) heart disease.
a. Congenital heart disease: Risk depends upon the specific lesion (Table 2-1) but in general ranges from 5% to 13%.
3. Maternal autoimmune disease, specifically those associated with anti-Ro or anti-La autoantibodies (4%-25% risk in affected women).
a. Fetal atrioventricular heart block typically appears after 17 weeks’ gestation in a mother with autoantibodies and with or without clinical autoimmune disease.
b. Fetal cardiomyopathy with endocardial fibroelastosis.
4. Exposure to teratogens such as:
a. Alcohol: Atrial and ventricular septal defects.
