Ensuring cardiac obstetrical screening for all pregnancies is imperative. Although initial studies reported a diagnostic accuracy as low as 26%, advancements in imaging technology and professional training have significantly bolstered this figure. Referral for fetal echocardiography in low-risk pregnancies is contingent upon the obstetrician’s clinical judgment. The legal ramifications associated with these tests remain ambiguous. Specific indications for referring for fetal echocardiography may include the following
Abnormal obstetric cardiac screening
- Suspected cardiac anomaly
- Left-right disproportion
- Tachyarrhythmia, isolated ectopy
- Bradycardia/heart block
- Hydrops Fetalis
- Left superior vena cava /Aberrant subclavian artery/ Right Aortic Arch
- Absent Ductus Venosus
- Intracardiac Echogenic Foci
Extracardiac anomaly in Ultrasonography
- Central nervous system
- Diaphragmatic hernia
- Gastrointestinal, Tracheoesophageal fistula, and other Atresias
- Omphalocele and other Abdominal and thoracic wall defect
- Genitourinary
- Single umbilical Artery
- Small or Absent Thymus
Abnormal early screening
- Increased NT value,
- Chromosome abnormality- cfDNA testing, Amniocentesis, CVS
- Monochorionic twin
Teratogen exposure
- Antiepileptics
- Antidepressants
- Antihypertensives
Maternal disease or exposure
- Febrile illness
- Pregestational diabetes
- Phenylketonuria Obesity
Autoimmune disease
In vitro fertilization (IVF)
History of Congenital Heart Disease and Genetic Disease in the Family or
- Mother or Father or Sibling with Heart Defect of repaired heart defect
- First- or second-degree relative with structural CHD with or without proven genetic association
- Communities with increased known risk of CHD
For cardiac Output calculations in High Output states
- Fetal anemia- Immune /Non-immune /Infections
- Non-anemic volume load
- Twin-twin transfusion
- Arteriovenous malformations
- Sacrococcygeal teratoma
- Agenesis of ductus venosus
- Aneurysm of the vein of Galen
Fetal Cardiac Care 