Fetal Echocardiogram

Overview

A fetal echocardiogram (often shortened to 'fetal echo') is a detailed ultrasound scan of your unborn baby's heart. It uses sound waves to build pictures of the heart's chambers, valves and blood vessels, and to show how blood flows through them. It is not an X-ray, it does not hurt, and the scan is done from outside your tummy. Think of it as a close-up, specialist look at the heart, done by a doctor trained in scanning babies' hearts before birth.

A fetal echo is not offered to everyone. Most pregnancies only need the routine scans. It is, however, a common test in specialist clinics, because roughly 1 in 100 babies is born with some kind of heart difference. Checking the heart before birth helps families understand what to expect and plan ahead.

It is offered to pregnant people whose baby has a higher chance of a heart problem. That might be because of a family history of heart problems, a previous baby with a heart difference, a finding on a routine scan, a twin pregnancy, or a health condition in the parent such as diabetes. It can also be done simply to check a worry. Many people who have the scan get a normal result.

Symptoms

Common symptoms

• A fetal echo is a test, not an illness, so there are no symptoms that tell you it is needed. You cannot feel your baby's heart structure from the outside.
• The scan is usually arranged because of a risk factor, a family history, or something seen on a routine pregnancy scan — not because you feel unwell.
• Some babies with a heart difference have no signs at all before birth, which is exactly why the scan is useful.

Symptoms in children

• This scan is only done before birth. After birth, signs that a newborn may have a heart problem can include blue or grey lips and skin, fast or heavy breathing, poor feeding, sweating while feeding, unusual sleepiness or floppiness, or not gaining weight.
• These signs can have many causes, and most are not heart problems. If you notice any of them in your baby, contact your midwife, health visitor or doctor the same day, or call your local emergency number if your baby is struggling to breathe or looks unresponsive.

Symptoms in older adults

• Not applicable for this scan, which is only done during pregnancy.
• Some heart conditions found before birth are lifelong. People born with them usually have their own follow-up care as children and adults, and many lead full, active lives.

Causes

Main causes

• There is no single cause for needing the scan — it is a way of looking for heart differences, not an illness in itself.
• Some babies have a heart that formed differently in early pregnancy (called a congenital heart defect). The exact reason is often unknown.
• Some babies have an irregular heartbeat before birth. This is sometimes temporary and settles by itself.
• Some heart findings are linked to gene or chromosome differences, which your team may offer tests for.
• Some are linked to the parent's health in pregnancy, such as poorly controlled diabetes, or to certain infections or medicines.

Risk factors

• A close family member, or a previous child, with a heart problem
• A heart difference seen on the routine 18–20 week scan
• Type 1 or type 2 diabetes in the pregnant parent, especially if blood sugar control is not steady
• Taking certain medicines during pregnancy — never stop a medicine without asking your doctor first
• Certain infections in early pregnancy, such as rubella (German measles)
• IVF or other fertility treatment
• A twin or multiple pregnancy
• Drinking alcohol or smoking during pregnancy
• Some gene or chromosome conditions in the baby

When to see a doctor

See a doctor urgently if:

• You notice your baby is moving less than usual — call your maternity unit immediately, at any hour
• You have bleeding, fluid leaking, or strong tummy pain
• You feel very unwell, have a high temperature, or have severe headache with vision changes
• You are very anxious about the scan or the results and feel you cannot cope — ask to speak to your midwife or the fetal medicine team the same day

Book a routine appointment if:

• You have a family history of heart problems and want to know whether a fetal echo is right for you
• Your routine scan showed something that needs a closer look
• You have diabetes or another long-term condition and are planning a pregnancy, or are already pregnant
• You are taking regular medicines and want to check they are safe in pregnancy
• You have questions about what the scan involves, or what a result might mean

Diagnosis

The fetal echo is the test itself. A specially trained doctor (often a fetal cardiologist) moves a small probe over your tummy with gel, and a screen shows your baby's heart from different angles. They check the heart's size and shape, the valves, the big blood vessels, the speed and direction of blood flow, and the heartbeat rhythm. There is no needle, no radiation, and no need for a full bladder. The doctor can often tell you what they see at the end of the scan, though a written report may follow.

Tests that may be done

• Fetal echocardiogram — the specialist heart scan itself
• Routine mid-pregnancy anomaly scan, which often comes first and may lead to a fetal echo
• Heart rhythm tracing during the scan, to check the baby's heartbeat pattern
• A repeat fetal echo later in pregnancy, if the first one was early or unclear
• Blood tests or fluid tests offered by your team if a gene or chromosome cause is suspected
• A heart scan of your baby after birth, if anything needs checking or following up

What to expect at your appointment

You will usually lie on a couch with your tummy uncovered. Gel is applied and the probe is moved around — it does not hurt. The scan can take 30 to 60 minutes because the doctor needs your baby to be in a helpful position, and they may ask you to change position or take a short walk. You can usually bring someone with you, though some clinics have rules about children attending, so it is worth checking. Sometimes a second appointment is needed for clearer pictures. You may feel tired or emotional afterwards, and it helps to have someone to talk things through with.

Treatment

The scan itself needs no treatment and no recovery time. If the heart looks normal, you go back to your usual pregnancy care. If something is found, you will be looked after by a team that may include a fetal medicine doctor, a children's heart specialist, a midwife and a genetic counsellor. Together you will make a plan for the rest of the pregnancy, the birth, and the first days of your baby's life.

Self-care at home

• Write down your questions before the appointment — it is easy to forget them on the day
• Ask if you can bring a partner, relative or friend for support
• Ask for the result to be explained in plain words, and ask for it in writing if that helps
• Keep up your usual pregnancy care, including your routine appointments and healthy eating
• Take time afterwards to process what you heard, and tell your midwife if you feel low or anxious

Medical treatments

If the heart rhythm is too fast or too slow, doctors may give medicines to the pregnant parent, which travel to the baby and can help steady the heartbeat. This is done in a specialist unit with close monitoring. If a structural heart difference is found, treatment usually happens after birth rather than before. In some situations, the team may plan for your baby to be born in a hospital with a specialist baby unit and children's heart services, so help is on hand straight away. All decisions are made with you, and you will be told the benefits and risks of each option.

When is surgery considered?

Surgery is only considered if your baby has a heart difference that cannot be managed with monitoring or medicines. Most heart surgery for these conditions is done after birth, sometimes in the first weeks or months of life, and sometimes later in childhood. Only rarely is a procedure needed before birth, and only in specialist centres. If this applies to you, your team will explain it carefully and give you time to decide.

Living with this condition

If your scan is normal, life carries on as usual. If something is found, day-to-day life may include extra appointments, travel to a specialist centre, and planning where and how your baby will be born. Many families find that a written plan and a named contact help them feel more in control.

Lifestyle tips

• Keep active in pregnancy at a level that feels comfortable — ask your midwife what suits you
• Avoid alcohol and smoking, and ask for help to stop if you need it
• Get plenty of rest, especially around appointment days
• Keep a simple folder or phone note with your appointment dates, results and questions
• Accept offers of practical help from friends and family

Diet and exercise

Eat regular balanced meals, including fruit, vegetables, wholegrains, protein and dairy or dairy alternatives, and take the pregnancy supplements your midwife recommends. Gentle everyday activity such as walking, swimming or pregnancy yoga is good for your mood and circulation. If your baby has a heart condition, ask your team whether anything should change — usually normal pregnancy activity is fine.

Mental health and emotional wellbeing

Waiting for a scan, or hearing unexpected news, can bring worry, shock, sadness or guilt. All of these are normal. Some people find the anxiety comes in waves, and appointment days are the hardest. Talking helps — to your partner, a friend, your midwife, or a counsellor. If low mood, panic or sleeplessness is affecting your daily life, please tell your midwife or doctor; support is available and asking for it is a sign of strength. If you ever feel you cannot keep yourself safe, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot prevent the need for a scan, but you can lower some risks to your baby's heart. Good care before and during pregnancy makes a difference: taking folic acid as advised, keeping diabetes well controlled, avoiding alcohol and smoking, checking any medicines with your doctor, and getting prompt treatment for infections.

Vaccines

Check with your doctor or midwife that your vaccinations are up to date before pregnancy — especially protection against rubella (German measles), which can affect a baby's heart if caught in early pregnancy. Vaccines in pregnancy are offered for your protection and your baby's; ask your team which ones are recommended for you.

Screening programmes

All pregnant women are offered a routine scan at around 18 to 20 weeks, which looks at the baby's heart along with other organs. If anything looks unusual, or if you have other risk factors, you may be offered a fetal echocardiogram as a follow-up. Screening cannot find every heart difference, but it finds many of them.

Complications

If left untreated

• If a heart difference is present and not found before birth, a baby may become unwell in the first days of life — for example with low oxygen levels, fast breathing, or difficulty feeding.
• Some babies grow more slowly in the womb or need extra support at birth, which is easier to plan for when the condition is known in advance.
• Parents may feel unprepared and frightened if problems appear suddenly after birth rather than being discussed beforehand.

Long-term outlook

The outlook is good for most families. The large majority of fetal echoes are normal. When a heart difference is found, many can be watched, treated with medicines, or repaired with surgery, and most children born with a heart condition now grow up to live full and active lives. Finding it early means your baby gets the right care from the very first day, and you have time to ask questions, make plans, and gather support around you.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.