A fetal echocardiogram takes a closer look at your baby's developing heart. Learn when it may be advised, what happens during the scan and what results can mean.
Hearing the words “fetal echo” after an ultrasound can leave parents with a lot of questions. Why is another scan needed? Did the earlier scan show something abnormal? Is there a problem with the baby's heart?
A fetal echocardiogram is a detailed ultrasound examination of the baby's heart before birth. It allows a specialist to examine the heart more closely than the cardiac views obtained during a routine pregnancy ultrasound.
Being advised to have one does not, by itself, mean that a heart problem has been found. Sometimes the reason is a finding on an earlier scan. In other pregnancies, a maternal condition, family history or another risk factor may make a more detailed assessment appropriate.
Here is what fetal echocardiography involves, when doctors may recommend it, what it can show and what parents can expect from the result.
Fetal echocardiography is essentially a closer look at the baby's heart before birth.
During a routine pregnancy scan, the sonologist assesses the baby's overall anatomy. The heart is an important part of that examination. A fetal echocardiogram goes further by using a more detailed set of cardiac views.
The specialist looks at how the different parts of the heart are formed and connected. Depending on the clinical situation, the assessment can include:
This matters because not all heart abnormalities are obvious from a single view.
For parents, the simplest distinction is this:
An anomaly scan looks at the baby's whole body, including the heart. A fetal echocardiogram concentrates specifically on the heart.
ISUOG recommends a systematic fetal cardiac examination that includes assessment beyond the four-chamber view, because some congenital heart abnormalities may not be apparent from the four-chamber view alone.
A detailed fetal echocardiogram is commonly performed around 18 to 22 weeks of pregnancy.
That timing is not an absolute rule. The appropriate timing depends on why the examination has been recommended, what was seen on an earlier scan and the individual pregnancy.
In selected situations, cardiac assessment may be considered earlier. Because the fetal heart is very small at an early gestational age, an early examination may sometimes need to be followed by another assessment later in pregnancy.
So if your doctor recommends a fetal echo at a different stage of pregnancy, it does not necessarily mean that something is wrong. The timing is determined by the clinical reason for the examination.
There isn't one single reason for a fetal echo.
Sometimes the scan is recommended because the doctor has actually seen something that needs a closer look. In other cases, the baby's heart looks normal on screening, but the pregnancy has a factor associated with a higher risk of congenital heart disease.
Some of the situations in which fetal echocardiography may be considered include the following.
This is an important reason for referral.
During the routine anomaly scan, the doctor may notice that one of the cardiac views is unusual or difficult to interpret. There may be a question about the four chambers, the heart's position, the outflow tracts, the major vessels or the rhythm.
That does not automatically mean that the baby has a heart defect.
Sometimes the fetal position makes the images difficult to obtain. Sometimes an apparent finding needs a more detailed examination before its significance can be understood.
A fetal echocardiogram can help answer that question.
Nuchal translucency, or NT, is a measurement obtained during the first-trimester ultrasound.
An increased NT measurement can be associated with several fetal conditions, including congenital heart disease. It is a risk marker, however, rather than a diagnosis.
The decision to perform fetal echocardiography depends on the NT measurement and the rest of the clinical picture.
The 2023 American Society of Echocardiography recommendations identify an NT measurement of 3.5 mm or greater as an indication for fetal echocardiography. For measurements between 3.0 and 3.4 mm, fetal echocardiography may be considered depending on the clinical setting and other factors.
So an increased NT does not mean that a heart abnormality has been confirmed. It means that additional assessment may be appropriate.
If a previous child or pregnancy was affected by congenital heart disease, your doctor may recommend a fetal echocardiogram in a subsequent pregnancy.
The significance of the history depends on the type of heart condition and whether an underlying genetic cause is known.
Having a previous affected pregnancy does not mean that the same condition will occur again. It is one factor that may influence the decision to perform a more detailed fetal cardiac examination.
Pre-existing, or pre-gestational, diabetes is another recognised indication for fetal echocardiography.
This is worth distinguishing from gestational diabetes. The two situations are not automatically treated as equivalent when deciding whether a fetal echo is required.
The 2023 ASE recommendations list pre-gestational diabetes as an indication for fetal echocardiography. Gestational diabetes diagnosed later in pregnancy, in the setting of a normal cardiac screening examination, does not carry the same recommendation.
Your doctor will consider the type of diabetes, when it was diagnosed and the findings from the pregnancy scans.
Some genetic conditions and fetal ultrasound findings are associated with congenital heart abnormalities.
If such a finding is identified, the doctor may recommend a fetal echocardiogram along with other appropriate investigations or genetic counselling.
The reason for the recommendation depends on the specific finding. There is no single approach that applies to every genetic screening result or ultrasound marker.
Some maternal medical conditions can increase the risk of fetal cardiac problems.
For example, certain autoimmune conditions involving SSA/SSB antibodies can be relevant to fetal cardiac assessment. Other specific maternal conditions may also lead to referral.
This is why the doctor's recommendation is based on the complete medical history rather than on one isolated factor.
Pregnancy following IVF may be another reason for discussing fetal echocardiography.
However, IVF alone does not mean that every pregnancy requires a fetal echo.
The 2023 ASE recommendations describe IVF as a situation in which fetal echocardiography may be considered, depending partly on the quality of the routine cardiac screening and the circumstances of the pregnancy.
Your obstetrician or fetal medicine specialist can explain whether an additional heart scan is appropriate in your particular case.
A fetal echo involves more than simply looking at whether the baby's heart is beating.
The specialist assesses the anatomy and function of the developing cardiovascular system using multiple ultrasound views.
The fetal heart has four chambers: two atria and two ventricles.
The specialist examines their size, structure, relationship and movement.
Differences between the chambers can sometimes provide clues that further assessment is needed.
The position of the heart within the baby's chest is also assessed.
The cardiac axis, which describes the orientation of the heart, can provide useful information when evaluating fetal cardiac anatomy.
The valves between the heart chambers and the major vessels are assessed as part of the detailed examination.
Their movement and associated blood flow can help the specialist evaluate how the heart is functioning.
The specialist examines the pathways through which blood leaves the heart.
This is particularly important because some congenital heart abnormalities may not be obvious when looking only at the four chambers.
The relationship and appearance of the major vessels connected to the heart are assessed using appropriate ultrasound views.
These views can provide information that is not available from the basic four-chamber examination alone.
The specialist also assesses the fetal heart rhythm.
If an irregular rhythm is suspected, further monitoring or assessment may be advised depending on the circumstances.
Doppler ultrasound can be used to examine blood flow through selected parts of the fetal circulation.
This provides additional information about the cardiovascular system beyond simply looking at the heart's structure.
This is one of the most common questions parents have.
The two examinations overlap, but they are not the same.
| Routine anomaly scan | Fetal echocardiography |
|---|---|
| Examines the baby's overall anatomy | Focuses specifically on the heart |
| Includes routine fetal cardiac screening | Provides a more detailed cardiac assessment |
| Looks at the brain, spine, face, heart, abdomen, kidneys, limbs and other structures | Examines cardiac anatomy, connections, rhythm and blood flow as appropriate |
| Usually performed as part of routine pregnancy screening | Usually recommended when there is a specific indication |
| Can identify many structural heart abnormalities | Provides more detailed evaluation when a cardiac concern exists |
Routine anomaly scan: Examines the baby's overall anatomy
Fetal echocardiography: Focuses specifically on the heart
Routine anomaly scan: Includes routine fetal cardiac screening
Fetal echocardiography: Provides a more detailed cardiac assessment
Routine anomaly scan: Looks at the brain, spine, face, heart, abdomen, kidneys, limbs and other structures
Fetal echocardiography: Examines cardiac anatomy, connections, rhythm and blood flow as appropriate
Routine anomaly scan: Usually performed as part of routine pregnancy screening
Fetal echocardiography: Usually recommended when there is a specific indication
Routine anomaly scan: Can identify many structural heart abnormalities
Fetal echocardiography: Provides more detailed evaluation when a cardiac concern exists
Fetal Echo vs Anomaly Scan: What's the Difference?
Think of the anomaly scan as a broad examination of the baby, while fetal echocardiography is a specialised examination of one particular organ system.
Neither scan completely replaces the other.
Yes. Routine fetal cardiac screening can identify many important heart abnormalities.
But it cannot identify every possible congenital heart condition.
The quality of the examination can be affected by factors such as:
Some abnormalities are also difficult to see before birth.
This is why a normal anomaly scan is reassuring but should not be interpreted as a guarantee that every possible heart condition has been excluded.
If the screening examination raises a concern, a detailed fetal echo may provide the additional information needed.
For most patients, the examination is performed through the abdomen using an ultrasound probe.
You will generally lie in a comfortable position while the specialist examines the baby using ultrasound. Gel is placed on the abdomen to allow the probe to produce clear images.
The examination may take longer than a standard ultrasound because the specialist needs to obtain several different views of the fetal heart.
You may see images of the heart on the monitor while the examination is being performed. The specialist may use colour Doppler or other ultrasound techniques to assess blood flow.
The baby does not always stay in a convenient position.
If the fetal back is facing the wrong direction, for example, some cardiac views may be difficult to obtain. The specialist may try again after the baby moves or may recommend a repeat examination.
An examination that is limited by fetal position is not the same as an examination showing an abnormal heart.
Fetal echocardiography uses ultrasound.
It does not use X-rays and does not involve inserting a needle into the uterus.
Ultrasound is widely used during pregnancy when medically indicated. Fetal echocardiography should be performed by appropriately trained professionals using suitable equipment and examination protocols.
If you have been advised to undergo the examination, your doctor can explain why it has been recommended and what information they hope to obtain.
This is often the part parents worry about most.
First, an abnormal fetal echo does not tell you the whole story by itself. Congenital heart disease includes many different conditions, and they can vary considerably in severity.
The specialist will usually explain:
In some pregnancies, the information may also help the medical team plan delivery and newborn care.
The goal of finding a heart abnormality during pregnancy is to give the parents and medical team time to understand the condition and plan appropriate care.
No.
There are many different types of congenital heart abnormalities.
Some are relatively mild. Others require specialist treatment after birth. Some findings identified during pregnancy may also require additional imaging before their significance becomes clear.
For this reason, the wording of an ultrasound report should not be interpreted in isolation.
If your report mentions a possible cardiac abnormality, discuss it with the fetal medicine specialist or paediatric cardiology team involved in your care.
A suspected finding is not the same thing as a confirmed diagnosis.
No.
This is an important limitation of even a detailed fetal heart examination.
Prenatal ultrasound can provide a great deal of information about the developing heart, but it cannot reproduce the same assessment that can be made after birth.
Some heart defects are difficult to detect during pregnancy. Others may become more apparent as the pregnancy progresses or only after the baby's circulation changes following birth.
Image quality also matters.
A baby's position, gestational age, maternal body habitus, the amount of amniotic fluid and the specific condition being looked for can all influence what can be seen.
So the right way to understand a normal fetal echocardiogram is that the baby's heart appeared normal within the limits of the examination. It is not a guarantee that no cardiac condition will ever be diagnosed.
This happens quite often during pregnancy ultrasound.
The baby's position can make it difficult to obtain a particular cardiac view. Sometimes the specialist simply needs to wait for the baby to move.
Depending on the situation, the examiner may:
If you are asked to return because the examination was incomplete, that does not automatically mean an abnormality was found.
It may simply mean that the specialist could not obtain all the images needed to complete the assessment.
No.
A separate fetal echocardiogram is not automatically required in every pregnancy.
The fetal heart is routinely assessed during the appropriate pregnancy ultrasound. A dedicated fetal echo is generally considered when there is a specific indication.
These may include:
The exact indications can vary depending on professional guidance, local screening practices and the details of the pregnancy.
Not every increased NT measurement means the baby has a heart problem.
NT is a screening marker. An increased measurement can be associated with chromosomal conditions, structural abnormalities and congenital heart disease, but it does not diagnose any of them.
The measurement itself is one factor doctors consider when deciding whether fetal echocardiography is appropriate.
For example, the 2023 ASE recommendations consider NT ≥3.5 mm an indication for fetal echocardiography, while measurements of 3.0 to 3.4 mm may warrant consideration depending on the circumstances.
Your doctor may also take into account other ultrasound findings, screening results and your pregnancy history.
It depends on the type and timing of diabetes.
Pre-gestational diabetes is recognised as a reason to consider fetal echocardiography.
Gestational diabetes diagnosed later in pregnancy is different. According to the 2023 ASE recommendations, gestational diabetes diagnosed after the second trimester, when the fetal cardiac screening examination is normal, is not by itself an indication for fetal echocardiography.
This distinction is easy to miss when reading general information online.
If you have diabetes during pregnancy, your obstetrician can tell you whether your individual history warrants a fetal cardiac assessment.
It is completely reasonable to ask questions before the examination.
You may want to ask:
These questions can be especially useful if you have been referred because of an unexpected ultrasound finding.
A fetal medicine consultation may be appropriate when a pregnancy requires more detailed assessment than routine obstetric care can provide.
You may be referred if:
A fetal medicine specialist can review the ultrasound findings together with the pregnancy history and explain what further assessment, if any, would be useful.
Fetal echocardiography is among the specialist fetal medicine services listed by Trichy Fetal Medicine and Fertility Centre, alongside anomaly scans, NIPT, fetal neurosonography, growth scans with Doppler and genetic counselling.
The centre's official information lists its location as 73, C/9, Annamalai Nagar, Thillai Nagar, Trichy - 620 018.
For someone in Trichy or Tiruchirappalli who has been advised to have a detailed fetal heart assessment, a specialist consultation can help explain why the scan is being recommended and what the examination is intended to clarify.
No.
Both are specialised fetal ultrasound examinations, but they examine different parts of the baby's anatomy.
Fetal echocardiography focuses on the baby's heart and cardiovascular system.
Fetal neurosonography provides a more detailed assessment of the fetal brain and central nervous system.
A doctor may recommend either examination, or both, depending on the findings and risk factors in a particular pregnancy.
The examinations are often performed during a similar period of pregnancy, but they are not simply two names for the same scan.
The anomaly scan provides an overall assessment of fetal anatomy, including standard cardiac screening.
A fetal echocardiogram is a more focused examination of the heart and is usually recommended when there is a specific reason for detailed cardiac assessment.
Whether the examinations are scheduled together or separately depends on the clinical circumstances and the imaging service available.
If the specialist finds that the baby's heart appears normal, they will explain the result and whether any further cardiac follow-up is necessary.
For many pregnancies, no additional specialised cardiac assessment is required unless another finding or risk factor changes the plan.
It is still useful to remember that fetal echocardiography has limitations. A normal result is reassuring, but it cannot exclude every heart condition that might become apparent later in pregnancy or after birth.
Being sent for a fetal echocardiogram can sound worrying, particularly if nobody has explained why the scan is being recommended.
In many cases, the reason is simply that the doctor wants a more detailed look at the baby's heart. Sometimes there is a finding on the anomaly scan that needs clarification. At other times, the recommendation is based on a known risk factor rather than something abnormal seen in the baby.
A fetal echo can provide valuable information about the developing heart, but it also has limits. A normal result is reassuring, while an unusual finding needs to be interpreted in context rather than assumed to represent a severe condition.
If you have been advised to undergo fetal echocardiography, ask what prompted the referral, what the specialist will be looking for and whether any follow-up is likely to be needed. Those answers can make the purpose of the examination much clearer.
For patients seeking fetal medicine consultation in Trichy, Trichy Fetal Medicine and Fertility Centre provides specialist fetal medicine services, including fetal echocardiography. The official website is fmctrichy.com.
If this applies to your pregnancy, our fetal echo page explains what the visit involves, or you can meet our specialists before you decide anything.
This guide is for general information and does not replace a consultation with a fetal medicine specialist.
In line with the PCPNDT Act, we do not perform or support sex determination.
Fetal Echo
A focused ultrasound of your baby's heart that checks its structure, function, and rhythm.
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