Fetal Echocardiogram

A fetal echocardiogram is a detailed ultrasound imaging test during pregnancy. This test can show how a fetus’ heart is forming and how well it’s working. It can also help diagnose possible heart defects, rule out other suspected conditions and guide treatments for after your baby is born. This test’s name is often shortened to fetal echo.

How does the test work?

A fetal echocardiogram uses ultra-high-frequency sound waves to create a moving picture of a fetus’ heart, inside and out. It can show the heart’s movements as it beats. It can even show how the valves inside the heart are working.

While a fetal echo works basically the same as a regular pregnancy ultrasound scan, there are important differences. Fetal echocardiograms are more detailed and look for more specific issues. Some of the things that a fetal echo looks for include:

• Shape, size and structure of the fetus’ heart and great vessels
• How the heart beats
• How much blood flows through the heart and the direction it flows
• Muscle damage
• Growths or tumors
• Irregular heart rhythms

What to expect during a fetal echocardiogram

There are two ways to do fetal echocardiograms. The more common way is an abdominal ultrasound, which is performed through the skin of your belly. The less common way is a transvaginal ultrasound, which involves placing a device into your vagina.

For the abdominal method:

1. You may change into a hospital gown. An ultrasound tech will ask you to lie on your back on a reclining exam table.
2. The tech will have you adjust what you’re wearing so your belly is uncovered and easy for them to reach. Then, they’ll apply a lubricating gel to your belly. The gel helps a small device called a transducer move smoothly across your belly and helps sound waves travel into your body.
3. After they apply the gel, they’ll place the head of the transducer against your belly and move it around so they can look at the fetus from all the needed angles.

For the transvaginal method:

1. You may change into a hospital gown. Or your ultrasound tech may ask you to remove your clothing from the waist down and give you a disposable covering and drape.
2. The tech will place a small, wand-like transducer into your vagina (like how you put in a tampon). That lets them get a direct look at the fetus.

During either method, the tech may pause a few times to take notes, make measurements and save images. That’s simply part of the fetal echo process. It doesn’t automatically mean they’ve found a concern.

What to expect after a fetal echocardiogram

After a fetal echo, your healthcare provider will share the results. They’ll tell you if what they saw looked normal or if they saw anything concerning.

Sometimes, a fetal echo doesn’t give clear results. There are many reasons why that might happen. For example, the fetus might not be in the right position. Or it may not have developed enough for all the heart structures to be clearly visible. If this is the case, your provider may recommend a follow-up scan.

If your provider sees anything concerning, they’ll explain more and recommend next steps. If you have any questions about what the scan shows, don’t hesitate to ask your provider.

Why would a fetus need an echocardiogram?

Your healthcare provider might recommend a fetal echo if:

• At least one biological parent has a history of congenital (present at birth) heart defects.
• There’s a risk that the fetus was exposed to an illness or substance that might affect development.
• You notice any differences or changes in how the fetus behaves during your pregnancy.
• You already have a child with a congenital heart condition.
• The fetus has other congenital conditions.
• You have a family history of genetic diseases that might affect heart development.
• Lab testing, like bloodwork or fluid from an amniocentesis, gives your provider a reason to suspect a condition that might affect fetal development.
• Other tests, like a fetal electrocardiogram, show the fetus has an irregular heart rhythm.

Your provider can tell you more about why they recommend a fetal echocardiogram and how this test might help guide your pregnancy or treatments.

At what week is a fetal echocardiogram done?

You can have fetal echocardiograms as early as 14 to 16 weeks into your pregnancy. Some congenital heart defects are visible that early. This usually only happens when healthcare providers are screening for an issue (like an inherited condition), or there’s a reason to suspect the fetus has a congenital heart condition.

In general, a fetal echocardiogram usually happens sometime between 18 and 22 weeks into pregnancy. Sometimes, you’ll have more than one throughout your pregnancy. That’s so your provider can track the fetus’ heart development, which can be a key clue to diagnosing certain conditions.