Questions to Ask Your Doctor During a Fetal Echocardiogram

A fetal echocardiogram is an imaging test that allows a doctor to observe the structure of an unborn baby’s heart to look for any potential heart conditions.

If you have been referred to a fetal cardiologist for a fetal echocardiogram, we understand you may have a lot of questions and concerns. Our top priority is for you to feel heard. Our fetal cardiologist, Dr. Sanghee Ro, breaks down some of the most important things you should ask your fetal cardiologist about your baby’s heart, and why it is important to ask them during your appointment.

What is a Fetal Echocardiogram, and Why Do I Need One?

"A fetal echocardiogram, also known as a fetal echo, is an ultrasound test that uses soundwaves to visualize the baby’s heart,” Dr. Ro explains. “The soundwaves pass through the pregnant mom’s belly to look at an unborn baby’s heart to see how well the heart is working.” Fetal echocardiograms are highly sensitive and able to create detailed images of your unborn baby’s heart so the doctor can take a more detailed look at the heart’s structure and make sure your baby’s heart is functioning the way it should."

Fetal echocardiograms are performed by fetal cardiologists, who are special pediatric cardiologists with expertise in ultrasound imaging of a fetus’s heart. This means they are able to scan through a mom’s pregnant belly to diagnose congenital heart defects (CHDs) in the fetus. Typically, women are referred to a fetal cardiologist by a maternal fetal medicine specialist if the 20-week ultrasound or anatomy scan shows a possible heart condition in the fetus; the mother, father or siblings of the unborn baby have a history of heart problems; or if the mother has a medical condition or has been exposed to certain medicines that can affect the development of the unborn baby’s heart.

Question 1: Is the heart function normal?

During your fetal echocardiogram, ask your doctor if your baby’s heart is pumping as it should be. Your baby’s heart should be pumping oxygen and nutrient-rich blood throughout the body and back to the heart in a very specific way.

“To make sure a heart is pumping normally, we look at the size and movement of the two pumping chambers in the heart, also known as the ventricles,” says Dr. Ro. “We have specific measurements to determine how much blood flow is coming out of the right and left pumping chambers. There are ways we can measure that to decide if the amount of squeezing is normal or not.”

Learn more about how the heart works. 

Question 2: Is the heart rate normal?

“Normally, a baby's heart rate is between 120 to 180 beats per minute,” explains Dr. Ro. “If a baby's heart rate is outside of this range, it may mean the baby has an arrhythmia, also known as an abnormality to the electrical system of the heart. If a heart rate is higher, it may mean the baby has tachycardia which can be in the form of supraventricular tachycardia, atrial flutter or ventricular tachycardia. If the heart rate is lower, it may mean the baby has a degree of heart block. The heart rate and rhythm are assessed during the fetal cardiac visit and the fetal cardiologist will work to determine the next best steps and treatment for the baby.”

Some conditions associated with fetal tachycardia include:

• Supraventricular tachycardia (SVT)
• Atrial flutter
• Ventricular tachycardia

There are also rare cases where the baby’s heart rate is too low, a condition called bradycardia which can be associated with maternal or fetal conditions that would require some follow up. While it is often temporary and goes away on its own, in some cases, it caused by other conditions, including:

• AV block
• Partial heart block
• Complete heart block

If your baby has an arrhythmia, your pediatric cardiologist will carefully weigh the different treatments available and choose the best one for you and your baby.

Question 3: Do you see all of the heart's chambers?

The heart typically has four chambers. It has two upper collecting chambers called atriums and two lower pumping chambers called ventricles. Each side of the heart has an atrium and a ventricle. On the right side of the heart, the right atrium collects the blue blood that comes back from the body, drops it into the right-sided pumping chamber, or ventricle, and that right ventricle pumps blood through the long artery out to the lungs. And then the same thing happens on the left side—the left atrium then collects that red blood that comes back from the lungs, dumps it into the pumping chamber on the left ventricle, and that left ventricle pumps blood out of the aorta, which is the big red body artery that carries that oxygenated blood out.

If your doctor sees an issue with one of the heart chambers or ventricles, your child could have one of a list of conditions affecting the chambers and ventricles, including:

• Hypoplastic left heart syndrome
• Hypoplastic right heart syndrome
• Pulmonary atresia
• Double outlet right ventricle
• Double inlet left ventricle
• Unbalanced atrioventricular canal defect

Asking your fetal cardiologist if they are able to see the heart’s chambers can help verify that your baby’s heart is functioning as it should. The Single Ventricle Program at the Children's Heart Center specializes in the diagnosis and treatment of conditions affecting the heart's chambers.

Question 4: Are you able to see the great arteries?

The great arteries refer to the two main arteries that come out of each side of the heart. The aorta is the main artery that comes out of the left side of the heart, and it carries the red oxygenated blood out of the left side of the heart and out to the body.

The other great artery is the called the pulmonary artery and is sometimes referred to as the “lung artery.” The pulmonary artery carries blue blood from the right side of the heart to the lungs so that it can pick up oxygen. These arteries ultimately have many little branches, like a giant river that has a million tributaries, but these two main arteries are the are the primary vessels that come out of the heart itself.

“There are two great arteries that come out of the heart,” says Dr. Ro. “One artery carries blood with oxygen to the body, called the aorta, and comes from the left pumping chamber. The other artery carries blood without oxygen to the lungs, called the pulmonary artery, and comes from right side. If these great arteries are switched in position, we diagnose transposition of the great arteries—which means the aorta comes off the right pumping chamber and the pulmonary artery comes off the left pumping chamber. This is a heart lesion that will require surgery as a newborn and close monitoring once the baby is born.”

Question 5: Are the heart and stomach in the correct position?

While the stomach position doesn't impact the function of the heart, abnormal positions of the stomach and the heart can be associated with a condition called heterotaxy syndrome, which can be related to complex forms of CHD. In heterotaxy syndrome, structures in the body that would normally either lie on the right or the left side can sometimes be switched. This means that a left-sided stomach (which is normal) could sometimes sit on the right side of the baby or structures that normally sit on the left side, such as the spleen, are sometimes abnormal or even missing.

Question 6: What are my next steps?

“Having a baby with a heart condition is incredibly challenging,” Dr. Ro acknowledges. “The most important piece of advice I can give families is to ask questions and be as informed as possible to prepare for the baby's birth. I always advise families to not be afraid to ask questions so they can get as much information as they need to make important decisions about their child's health. There are no bad questions.” 

If our team identifies a heart problem, an important part of our process is to sit down with you to counsel you, explain the condition and how it is treated, and carefully explain what this means for your baby.

Some additional questions you should ask include:

• Do I need a special delivery plan?
• Will the baby need any medications to be started after birth?
• Will the baby need any surgery after birth?
• Is this heart program nationally ranked in pediatric heart care?
• How many of these conditions do you treat each year?

We will work with the maternal-fetal medicine specialist and will provide resources so that you can make informed decisions for your family. If your baby’s condition requires heart surgery, we will walk you through every step, from diagnosis to treatment, so you are prepared for the road ahead.

Dr. Sanghee Ro is a board-certified pediatric cardiologist who specializes in fetal cardiology, clinical echocardiography and general pediatric cardiology. In addition to providing patient care, Dr. Ro serves as a faculty member at the Emory University School of Medicine. 

This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.