What is importance of congenital heart diseases in new born babies?

Newborn babies with undiagnosed congenital heart disease ( CHD) (like, trans position of great arteries, pulmonary atresia, coarctation of aorta etc ) are at risk of developing life threatening complications within short period after birth. In fact they are the leading cause of early neonatal mortality. With timely diagnosis and intervention, most of these defects are treatable and babies can enjoy a healthy life.2D echocardiography helps to diagnose problems with heart structure and function with greater accuracy.

What is a fetal echocardiography (fetal echo)?

Baby in mother’s womb is called as fetus. Echocardiography examination of fetal heart is called as Fetal Echo. It gives detailed information about structure and function of heart,congenital heart defects, problems with heart rhythm or rate (Arrhythmia) , cardiomyopathy etc.After birth of baby, these defects are confirmed with help of 2D Echocardiography.

What will paediatric cardiologist or counsel after the fetal echo?

The paediatric cardiologist will explain nature of defect in detail and along with that what can happen to child in womb and after birth. He will also discuss about need and timing of surgery/intervention as well as long term outcome. This discussion is diagnosis specific and includes morbidity, mortality at every step and over all life expectancy. This is a crucial piece of advice which will help expecting parents in decision making and prepare for child birth.

How will Fetal echo help the child yet to be born and expecting parents?

With the help of fetal echo, we can diagnose these problems well in advance. Delivery can be planned well equipped centre so that after birth, treating doctor can initiate necessary management without wasting valuable time and avert potentially life threatening complications. This advance planning will prevent un-necessary hassle to parents and save life of many babies.

If parents are not willing to continue pregnancy in a fetus with significant congenital malformation ( cardiac or any other defects), Indian law (MTP act) allows medical termination of pregnancy up to 20 weeks of gestation. It is done with consultation of treating obstetrician. The honorable supreme court of India has allowed medical termination of pregnancy beyond 20weeks in a few cases. However those are exceptions.

What is optimal time to perform fetal echo?

At Sujyot Heart Clinic, routine fetal echo is performed at 18 weeks and onward. In case of major cardiac anomaly, scan at 18 weeks gives time to parents to think and decide whether they wish to terminate pregnancy or continue. ( MTP act allows termination of pregnancy upto 20 weeks of gestations). The test can be performed as early as 14 to 16 weeks in high risk pregnancies.

What is accuracy of the test?

In an expert’s hand it is highly sensitive and specific for complex heart defects.

Which expectant mothers should consider fetal echo?

Ideally every pregnant mother should have fetal echo, it is not possible for logistic reasons. It is strongly recommended when there is high suspicion of CHD on routine screening sonography or presence of risk factors described below.

1. Familial: Previous sibling or any parent with congenital heart defect
2. Genetic/ inherited diseases: Noonan, Marfan, etc
3. Maternal risk factor:
   1. congenital heart disease,
   2. cardiac teratogen/ medicines
   3. maternal diabetes mellitus, phenylketonuria, rubella,
   4. Autoimmune diseases of mother (systemic lupus erythromatosus, etc)
4. Fetal risk factor:
   1. Abnormal obstetric ultrasound screening, suspected cardiac anomaly on screening,
   2. Extracardiac anomaly,
   3. Chromosomal abnormality ,
   4. Arrhythmia (abnormal heart rate too high or too low),
   5. Nonimmune hydrops fetalis ( excessive fluid accumulation, edema),
   6. Increased thickness of nuchal translucency (>3.5mm), (NT scan )
   7. Intra uterine growth retardation,
   8. Amniotic fluid abnormality of moderate to excess degree
   9. Twin gestation,
5. Advanced maternal age (>35yr),
6. Abnormal biochemical markers in maternal serum ( Triple / quadruple markers) ,
7. Assisted reproduction : Test tube baby/ IVF/ frozen embryo/ etc

What will doctor not tell you?

Doctor will not diagnose or disclose sex of fetus. PCPNDT act does not allow 1) sex determation and 2) sex selective medical abortion ( medical termination of pregnancy).It is a punishable offence.

Are there any side effects of echo on fetus?

This test uses only sound waves for imaging of heart and it has no side effects whatsoever on fetus or mother.