Fetal Cardiology

The fetal cardiology team specialise in diagnosing and treating children’s heart problems before birth.

Congenital heart disease (CHD) is common with approximately 1000 babies born each leaving hospital with a cardiac defect undetected and around 15% of these being life threatening. Most of these cardiac defects occur in low risk pregnancies and it is the role of the antenatal screening programmes (Fetal anomaly screening pathway programme (FASP) to try to identify those pregnancies affected before birth.

Many congenital heart conditions (CHD) can be identified before birth with an ultrasound scan (fetal echocardiogram) though some conditions remain difficult to detect.

Early antenatal detection of congenital heart defects avails woman and their partners the opportunity to receive accurate diagnosis and counselling, and supports onward pregnancy choice. Following diagnosis, appropriate management and care planning of affected pregnancies yields better clinical outcomes for babies and ensures effective support implementation for their families.

What is fetal echocardiography?

Fetal echocardiography is a test using sound waves (ultrasound) which allows the sonographer or doctor to better see the structures of your unborn babies’ heart.

Not all pregnant woman need a fetal echocardiogram, for most woman the fetal anomaly screening programme (FASP) Physical examination which is performed between 18-20+6 weeks will show the normal development of your babies heart. Sometimes this routine pregnancy ultrasound scan will detect a fetal heart abnormality and you will be referred to the Fetal cardiology team for a fetal echocardiogram.

You may also need the test if:

Some pregnant women are at a slightly increased risk of giving birth to a baby with congenital heart disease (CHD) and should be considered for referral for a specialist fetal echocardiogram routinely. Indications may include some of the following:

· A first degree relative of the fetus with CHD.

· An abnormal fetal heart rhythm

· A Nuchal translucency of >3.5mm

· Abnormality of another major organ system

· Maternal diabetes mellitus (insulin-dependent)

· Exposure to some drugs in early pregnancy, for example, some anti-epileptic drugs can damage the developing heart

· Abnormal fetal karyotype

· Monochorionic twins

· Maternal Anti Ro/La antibodies

Location

Clinics are held in the fetal medicine Units – Level E St Michael’s hospital in Bristol (Postcode BS2 8EG)

About your appointment

You will be contacted by the fetal cardiology administrators with a date and time for your appointment. Please bring your maternity notes with you.

When you arrive, please check in to the Fetal medicine reception on Level E St Michaels’ hospital and you will be asked to take a seat in the waiting room until you are called through to the scan room.

What will happen during my appointment?

This scan is similar to the routine anomaly ultrasound scan you have for your baby, except that it will concentrate on examining your baby’s heart and looking at it in greater detail.

We do not assess any other features of the baby’s anatomy and therefore we are unable to comments on previous scans you may have had, this includes the sex of the baby.

This scan is similar to the routine anomaly ultrasound scan you have for your baby, except that it will concentrate on examining your baby’s heart and looking at it in greater detail.

How long will my appointment take?

As a guide the scan may take around 30 minutes however the scan time may vary depending upon your baby’s position and the heart problem detected and may take up to 45 minutes to complete. It is similar to any other type of ultrasound scan and does not cause harm to your baby.

Each appointment is tailored according to individual needs. Sometimes this may cause delays to your appointment time. We appreciate that this can be a stressful time for you.

It is not necessary to have a full bladder for this scan.

Who will be present during my scan?

The fetal cardiology team consists of a consultant fetal cardiologist, a fetal cardiac sonographer and a cardiac nurse specialist who are all usually present during your consultation.

The fetal cardiac sonographer or fetal cardiologist usually performs the scan. At times, a trainee under consultant supervision may perform it.

As a major teaching hospital, it is possible other healthcare professionals will be present. No more than four people are usually present in the room, unless in special circumstances when you would be asked for your consent.

Please let us if you would rather not have extra people present.

How will I get the results of the scan?

If your baby is found to have heart condition, the fetal cardiologist will explain to you:

· The exact nature of the heart condition found.

· The likely treatment that may be needed after birth.

· The overall prognosis and long term outlook.

· The options available to you and the implications for your pregnancy.

You will have time to ask questions to clarify anything that you may not have understood during the discussion. Do not worry if you think of more questions after the appointment – you will be given contact details for the cardiac nurse specialist who will provide support to you.

Ultrasound recording

The scan of your baby’s heart will be recorded and images stored securely on the hospital system. These images remain confidential at all times. We may ask you for your consent to use imaging for teaching. In the instance that you are in agreement with this, all images used for these purposes will be anonymized.

Please note we will not be able to provide recordings for your own personal use.

We accept referral from obstetricians, midwives and GP’s

To refer to fetal cardiology please download the Fetal cardiology referral form on our website (accessed here) and email it to ubh-tr.bristolfetalcardiology@nhs.net

The Future

This department contributes information to The National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) & National Institute Cardiac Outcome Research (NICOR). The benefits of this include:

· Detection of birth abnormalities in the same area.

· Monitor the scanning and detection services you receive during pregnancy.

· Evaluate the necessary facilities provided in the hospitals and community services.

· Contribute to research questions about specific abnormalities such as cardiac defects.

We hope that your visit to the fetal cardiology department will be helpful and we will endeavor to answer all your questions. If you have any questions regarding your appointment, if you are unclear about what was said or are unhappy about anything that has happened during your visit, please contact the fetal cardiology team.

Fetal Cardiology team

The fetal cardiologists and sonographers provide training across the South west for sonographers to improve their ultrasound skills as well as participating in research studies.

Dr Patricia Caldas – Consultant in fetal and paediatric cardiology – Clinical lead for fetal cardiology

Dr Camilla Snook – Consultant in fetal and paediatric cardiology

Dr Mari Nieves Velasco – Consultant in fetal and paediatric cardiology

Dr Andy Tometzki – Consultant in fetal and paediatric cardiology

Angie Smith – Fetal cardiac & Midwife sonographer

Dr Jo Jones – Cardiac Physiologist

Josie Ryan – Cardiac Physiologist

Lisa Patten – Paediatric Cardiac Nurse Specialist

Ella Houghton – Paediatric Cardiac Nurse Specialist

Naomi Jones – Paediatric Cardiac Nurse Specialist

Adam Cockle – Senior administrator