Fetal Cardiac Imaging: When You Might Need It and Why it Matters

During pregnancy, your baby does an incredible amount of growing and developing. From just one cell, it divides over and over again to form the brain, lungs, limbs and those tiny fingers and toes. It also forms the heart, including the chambers, valves and everything else necessary for this organ to function properly.

While rare, complications can occur as your baby’s heart forms which can lead to a congenital heart defect (CHD) present at birth.

Congenital heart defects can impact the structure of your baby’s heart and how it works. They can range from mild — like a tiny hole in the heart — to severe — like a poorly functioning or missing part of the heart.

Just as your healthcare provider monitors your baby’s health in other ways, they’ll check on the heart’s development. Checkups include listening to your baby’s heart rate using a fetal Doppler at prenatal visits, and by performing an ultrasound between weeks 18 and 20 of your pregnancy to check for congenital heart problems.

In some cases, you may also need fetal cardiac imaging — a fetal echocardiogram — to provide an accurate and early congenital heart defect diagnosis. This detailed ultrasound is used to view your baby’s heart before they are born.

Here’s an overview of fetal cardiac imaging, including when you might need it and why it matters.

What Is a Fetal Echocardiogram?

Ultrasounds — or imaging tests that use sound waves to form a picture of what’s going on inside your body — are used during pregnancy to take images of your baby. You should have at least one routine ultrasound conducted by your obstetrician (OB) during your pregnancy, usually between 18 and 22 weeks.

A fetal echocardiogram is a detailed ultrasound that focuses on your baby’s heart. Using a transducer (or small camera) placed on the pregnant mother’s belly, this ultrasound sends sound waves to take pictures and capture the blood flow through the baby’s heart. A pediatric cardiologist will then be able to look at the structure and function of the heart and detect abnormalities, including congenital heart defects.

When Might I Need Fetal Cardiac Imaging?

Not all pregnant women need to undergo fetal cardiac imaging during their pregnancy. However, your provider may recommend a fetal echocardiogram if your baby has certain risk factors for congenital heart defects or suspected abnormalities.

Fetal cardiac imaging is recommended for:

  • Suspected heart abnormalities from routine ultrasounds conducted by your OB
  • A baby who is diagnosed with an abnormality of another body part or system
  • A diagnosis of a genetic abnormality in the baby, such as Down syndrome
  • Abnormal heart rate or rhythm of the baby’s heart
  • A family history of congenital heart defects, particularly in first-degree relatives of the baby
  • Mothers who have diabetes, phenylketonuria or autoimmune diseases like systemic lupus erythematosus
  • A family history of disorders that are passed down through generations, including Marfan’s syndrome or tuberous sclerosis
  • Mothers who have taken medications that can cause congenital heart defects, such as Accutane
  • Mothers who had infections during pregnancy, like rubella or cytomegalovirus (CMV)

What Happens If a Heart Defect Is Found During Fetal Cardiac Imaging?

If a heart defect is found, a pediatric cardiologist — or a cardiologist who is specially trained in heart problems in children and fetuses — will review the diagnosis, including what it means for your baby.

Your conversation will cover factors such as whether or not:

  • The heart defect will impact your baby before they are born
  • Your baby will need to be transferred to Children’s right after birth
  • Your baby will require heart surgery after they are born

You will also likely need to return for follow-up imaging as your baby continues to develop during your pregnancy.

Even if a heart defect is not found, you may still be asked to come back for follow-up imaging. It is also important to remember that a normal result cannot rule out heart problems completely because the heart works differently inside the womb compared to after birth.

With the help of fetal cardiac imaging and trained pediatric cardiologists, you can equip yourself with as much knowledge as possible about your child’s development and prepare for your child’s treatment before they are born.

Do you have questions about fetal cardiac imaging and if it is something you should get during your pregnancy? Ask your obstetrician (OB) or maternal-fetal medicine (MFM) specialist if you qualify. Children’s Fetal Care Coordinators are also available to help. To speak with a Children’s Fetal Care Coordinator, call 402-955-3030.


Search the Children's Nebraska Website

Looking for a provider?