Examination Technique, Indications, and Clinical Integration
Fetal echocardiography is integrated into prenatal care through appropriate indications, timing, and structured reporting. Common indications include family history of congenital heart disease, maternal diabetes, teratogen exposure, aneuploidy or extracardiac anomalies, abnormal screening cardiac views, fetal arrhythmia, hydrops, monochorionic twins, and growth restriction. The optimal screening window is often 18–22 weeks, but early or late examinations may be needed; late gestation can be limited by rib shadowing, fetal position, and decreased amniotic fluid. Use a systematic approach: confirm situs, sweep from abdomen to neck, obtain four-chamber, outflow tract, three-vessel trachea, and arch views, and use color Doppler for valves, septa, and venous connections. Sequential segmental analysis prevents missed diagnoses. Document image quality, structures seen, measurements, rhythm, and any limitations. Traps include assuming a normal four-chamber view excludes all CHD, failing to account for gestational age, and overreassuring when views are incomplete. Clinical integration means communicating findings to obstetric and pediatric cardiology teams, planning delivery site, and arranging postnatal evaluation. Worked example: a third-trimester fetus with suspected coarctation should have arch views, isthmus measurement, left ventricular and aortic valve assessment, and ductal flow evaluation; the report should state whether findings are definitive or limited, and the delivery plan should include neonatal cardiac assessment. Rule of thumb: a normal heart requires more than one normal view-sweep, cross-check, and document.