What Is a Fetal Echocardiogram?

pregnant ultrasound

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If you have been referred to a pediatric cardiologist for a fetal echocardiogram, you may be wondering what it is and what to expect. Generally speaking, a fetal echocardiogram is an ultrasound of your baby's heart that can be done as early as four months after conception.

The information provided during the ultrasound allows healthcare professionals to either rule out potential heart issues, treat problems before birth, or even plan for an emergency situation at birth. If you have an upcoming fetal echocardiogram, it's important to note that many times these tests are ordered for precautionary reasons.

So try not to panic if your healthcare provider refers you to a pediatric cardiologist. Even if a heart defect is found, the advances in medical technology allow for the vast majority of issues to be treated effectively. Here we break down the process of a fetal echocardiogram including when it is recommended and what you can expect.

What Is a Fetal Echocardiogram?

A fetal echocardiogram, which is sometimes called a fetal echo, is an ultrasound that uses sound waves to create pictures of your unborn baby's heart. Although the test may be performed by a sonographer, the images are interpreted by a pediatric cardiologist.

"A fetal echocardiogram is a subset of the ultrasound," explains Devyani Chowdhury, MD, MHA, a pediatric cardiologist, spokesperson for PA Chapter of the American Academy of Pediatrics, and the medical director of Adult Congenital Heart Disease at Nemours Cardiac Center. "It focuses specifically on the heart of the baby."

Dr. Chowdhury also indicates that the results of a fetal echocardiogram cannot be interpreted by just anyone. For the best results, these tests need to be performed by a pediatric cardiologist who is trained in looking at the whole heart, its structure, its connections, and its pumping abilities.

"A doctor that specializes in maternal-fetal medicine may look at the heart, but they do not have the background and training for the whole heart," Dr. Chowdhury explains. "Often parents are referred by maternal-fetal medicine or an obstetrician for a closer examination of the heart."

This painless test shows the structure of your baby's heart and how well it is working. Overall, this type of ultrasound is a safe procedure without any known significant risks to you or your growing baby.

"The good thing about a fetal echocardiogram is that we have the ability to diagnose a problem that can really impact the outcome," says Francine Erenberg, MD, a pediatric cardiologist with Cleveland Clinic Children's. "We can make sure the delivery occurs in the right place and that all the services that are needed are in place."

How It Is Performed

Most of the time, a fetal echocardiogram is performed in a darkened room while you are lying down. Although this test focuses on the baby's heart, it will appear very similar to the routine ultrasound you receive in your healthcare provider's office.

Gel will be placed on your belly which helps the sound waves travel from the echocardiogram transducer (or wand) to the baby's heart and back again. The person performing the test will move the wand around to get pictures of your baby's heart from different angles.

"The technology allows us to zoom in on the heart," says Dr. Chowdhury. "There are a lot of things we look at. We look at the structure of the heart, the function of the heart. We look for leakage, blockage, and make sure the rhythm is regular or if there is some irregularity. We also look to see if there is any fluid around the heart, that the four chambers are formed properly, that the blood is flowing in and out properly, and that connections all look normal."

Overall, the test lasts about 30 minutes to one hour. But it may last even longer if the position of your baby makes it hard to see the heart.

Additionally, there will be times that the pediatric cardiologist will take additional pictures after the sonographer has performed the bulk of the test. But once the scan is completed, they usually sit down with you to discuss the results.

"The main goal is to look for anything that would make the baby sick right away or a heart issue that would need an intervention right away like a valve didn't form or the blood vessels are not connected to the heart the right way," says Corey Stiver, MD, a pediatric cardiologist with expertise in fetal echocardiography at Nationwide Children's.

When It Is Performed

Your healthcare provider may refer you to a pediatric cardiologist for a fetal echocardiogram to determine if there are any major problems with your developing baby's heart. The pediatric cardiologist will look at the heart walls, valves, the blood vessels leading to and from the heart, and the heart's pumping abilities.

There are a variety of reasons in which a fetal echocardiogram may be done. For instance, if you have a family history of heart problems, your baby may have a genetic disorder like Down Syndrome, or your healthcare provider found an abnormality during a routine obstetrical ultrasound a fetal echo might be ordered. Most of the time, this test is performed around 18 to 24 weeks gestation.

"A fetal echocardiogram can be done earlier but that timeframe of 18 to 24 weeks is the ideal time for us to see things," says Dr. Stiver. "Even though the heart develops very early in gestation, at 17 or 18 weeks it is big enough for us to see the structures and make sure everything is formed the way it should be."

Dr. Stiver notes that fetal echocardiograms can be performed later in pregnancy, especially if a parent was late to prenatal care or their healthcare provider finds something suspicious. However, she indicates that it can be harder to get accurate pictures.

"As the baby gets bigger, the bones harden and it gets more difficult to see the heart outside of that sweet spot," she says.

Why Might I Need a Fetal Echo

There are numerous reasons why you may need a fetal echocardiogram, including:

  • Having a family history of genetic heart problems
  • Discovering a genetic issue with the fetus
  • Having a previous child born with a heart defect
  • Having a health condition like diabetes or lupus
  • Conceiving by assisted reproductive technology
  • Displaying abnormalities on fetal ultrasound including irregular beats
  • Receiving abnormal test results on other tests
  • Getting pregnant at an advanced age
  • Taking a medication known to cause defects
  • Abusing alcohol or drugs during pregnancy
  • Experiencing certain infections in pregnancy

What to Expect

Most of the time, people are referred to a pediatric cardiologist as a precautionary measure. So it is important not to worry about your upcoming test.

"A majority of fetal echocardiograms turn out to be normal," says Dr. Erenberg. "Even for people in high-risk situations, there is still a good chance the results will be normal."

For instance, if a parent has diabetes and has had normal ultrasounds throughout their pregnancy, it is likely that their fetal echocardiogram will be normal as well.

Even if an issue is detected, it is often long before birth giving you and your medical team plenty of time to engage in pre-delivery planning and determine how you are going to handle the situation so that you and your baby stay safe, says Dr. Erenberg.

It is also important to note that sometimes the abnormalities that are found are not serious or life-threatening problems, she adds. So, in those situations, you just follow up shortly after your baby's birth. For more significant defects, your baby may need immediate care right after they are born.

"We [Cleveland Clinic Children's] are in a unique situation where we have a special delivery unit for babies that need immediate care after birth, where you can deliver right there and both be cared for at the same place," says Dr. Erenberg.

Depending on your location, you may deliver in a nearby hospital and then have your baby transported by a medical team to the children's hospital for surgery. If you live in a remote area, you may have to explore other options if your baby has a serious heart defect.

"I know of one family that moved from Montana to Utah to deliver the baby," says Dr. Chowdhury. "Some parents choose to travel to a center where the outcomes are better. There are so many things to take into consideration."

It is also important to remember that a fetal echocardiogram is not designed to catch everything. Keep in mind that your baby's heart may only be 2 centimeters in size with very thin cardiac valves, so there is a possibility that something minor could be missed.

"There are things that we cannot predict, like changes in heart functions or if the heart muscle develops problems later in life," says Dr. Stiver. "But once the heart is formed it is formed. [So we are looking to see if everything is there and functioning properly.]"

Despite these limitations, you should feel largely reassured that there is a very low likelihood of congenital heart defect if you have a normal fetal echocardiogram.

What Happens if a Defect Is Found

If a defect is detected, most pediatric cardiologists will explain in detail what was found and what the next steps will be. After your initial appointment, you may be counseled by a team of professionals consisting of pediatric cardiologists, maternal-fetal medicine specialists, obstetricians, neonatologists, mental health professionals, and more.

"Depending on which heart defect is identified, we try to give the family a clear expectation of what to expect going forward," says Dr. Stivers. "We answer questions like will the baby need to come to the hospital right away or will they be able to be with whoever is in the delivery room first. There are some heart defects that don't need to have surgery until they are 4 or 5 months old and there are some that need surgery immediately. Anytime we can, we want to allow them to have a normal bonding experience."

If your baby has a significant defect that requires immediate care, you may meet with the medical team multiple times to not only monitor your baby's progress but also to make plans for what happens at birth.

"We want babies to be with their families, but there are times when we will ask them to transfer care if it's best for baby," says Dr. Stiver. "We counsel families and meet with them multiple times because there is a lot to think about. There is an entire team devoted to making sure they have as safe of delivery as we can."

Dr. Stiver also recommends that you keep a list of questions to ask each time you meet with your healthcare provider or the medical team assisting with you and your baby.

"Families under stress don't remember everything they want to ask so I always advise coming prepared with a list of questions," she says. "Also remember that one of the huge benefits of knowing about a fetal heart defect before birth is that you know how to prepare. You can lay a lot of fears to rest."

A Word From Verywell

If you have a fetal echocardiogram coming up, it is important not to worry too much about the test. Chances are good that your results will be normal. And even if a defect is found, it is likely that the issue can be addressed either before birth or after delivery.

Plus, knowing about a defect in advance of your baby's birth gives you plenty of time to prepare. If you have questions or concerns about your upcoming fetal echocardiogram—or if you think you have a situation that warrants one—be sure to talk to a healthcare provider.

4 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Minnesota Health. Four things you should know about fetal echocardiography.

  2. Nemours Kids Health. Fetal echocardiogram. Updated September 2019.

  3. Stanford Children's Health. Fetal echocardiography.

  4. Stony Brook University Hospital. What parents need to know about fetal echocardiography.

By Sherri Gordon
Sherri Gordon is a published author and a bullying prevention expert.