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DEBORAH FRIEDMAN, M.D., Pediatric Cardiologist
Chair, Department of Pediatrics, Saint Barnabas Medical Center
is the safe and noninvasive performance
of obstetrical ultrasound used specifically to image the unborn
child’s heart. We have been using this technique for
more than 20 years and have shown it to be harmless and painless,
but extraordinarily useful and accurate for assessing the
condition of the baby’s heart and circulation before
birth.
The test uses commonly available ultrasound equipment, is
readily available, and takes only about one half hour to complete.
The fetus can be seen in real time. The test results are available
immediately, and can be shared with the pregnant woman, her
family, and the referring obstetrician.
Not every normal pregnancy requires the testing, but there
are certain risk factors which suggest imaging may be useful.
These include a family history of birth defects of the heart
in close relatives, or other inherited conditions. Fetal
echocardiography is also indicated if the fetus shows signs
of a slow or irregular heartbeat, poor growth or other worrisome
signs such as an abnormal obstetrical ultrasound of the heart.
The mother’s health may dictate this scanning, if,
for example, she has diabetes or lupus or high blood pressure.
The presence of multiple gestations, twins or above, can
lead to heart problems.
The kind of information we get from such scanning includes
an excellent look at the structure of the fetal heart to
be sure there are no birth defects. In addition, we can repeat
the test over time to rule out developing problems. Measurements
can be made of the function of the heart muscle. For example,
with a poorly functioning heart or leaking heart valves,
fluid can accumulate around the heart or in other areas of
the fetal body, a situation of heart failure or “hydrops.” Abnormal
flow of blood can be seen with the Doppler technique of noninvasively
looking at the speed of blood flow. We can assess the growth
of the heart structures and identify areas that are not growing
well.
 We can assess the rate and rhythm of the heart, which can
sometimes be a problem. Some fetuses develop too rapid or
irregular heart beats, which may require close observation
or medical therapy. Some mothers with lupus or other autoimmune
diseases, or even healthy women with certain autoantibodies
in their blood, may have fetuses who develop a very slow heart
beat, known as congenital heart block. This situation requires
early detection and care.
The importance of fetal echocardiography lies in the ability
to offer early information during pregnancy. Suppose we discover
a heart problem in the fetus before birth. In the case of
a severe defect, we then have the ability to counsel the family
before the birth of the child, at a time when they can absorb
the information and prepare themselves. We can educate them
as to what to expect and what the choices are for care. They
can seek second or third opinions and decide on a treatment
plan.
Such discussions are much easier during the pregnancy than
in the case of a surprise birth of a sick child. Once the
child is born, the mother is indisposed and sometimes sedated,
there is little time for education, yet sometimes a great
need to make important health decisions immediately. Early
detection of cardiac problem also allows for the social and
psychological support of a family faced with the impending
birth of a sick child.
Many choices are available when heart disease is found in
a fetus. Sometimes the defect is mild and only counseling
is needed. In more severe cases, decisions about where to
deliver the potentially sick newborn who might need surgery
are necessary. There are some problems for which medical
treatment is indicated, for example, medications for arrhythmias
or heart block. In most cases, these medications need to
be administered to the healthy mother in order to treat her
fetus by passage through the placenta. There are some problems
that are so severe that termination of pregnancy is elected.
Fortunately, it has been shown that prenatal detection of
many severe forms of heart disease, such as transposition
of the great vessels or hypoplastic left heart syndrome, have
a more favorable outlook if they are diagnosed before the
baby is born. Most of these cases are born in specialized
surgical centers where they can be repaired before they show
signs of illness. Finally, for the most severe forms of congenital
heart disease, there are some experimental forms of fetal
surgery and invasive catheterizations available which may
show promise.
For information or referrals for fetal echocardiography,
contact your obstetrician.
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