Fetal Echocardiography: Who Needs It?

Fetal echocardiography is presently the definitive modality for diagnosing and evaluating fetal congenital heart disease (CHD). Fetal heart disease frequently occurs sporadically without a known risk factor; however, certain pregnancies carry a higher risk of the fetus having CHD. Various known factors place the pregnancy and fetus in a high-risk category. To understand "who needs a fetal echocardiogram," one must recognize and identify the risk factors. Referral indications for a fetal echocardiogram are based on these risk factors that include fetal chromosomal anomalies, fetal extracardiac defects, fetal arrhythmias, maternal teratogenic exposures, maternal metabolic risks, and various inherited syndromes. Referral indications are reviewed along with the associated risk of the fetus having a congenital cardiac abnormality. The anticipated cardiac defect based on the specific referral reason along with the associated frequency of CHD is also addressed. Reasons for performing a fetal echocardiogram, various modalities of imaging, and the benefits and limitations of a study are included. The question of who needs a fetal echocardiogram is closely enmeshed with recognition of the fetal, maternal, and familial risk factors.