Congenital heart disease is a leading cause of infant morbidity and mortality from birth defects with an estimated incidence of 6 per 1000 live births. Abnormalities of the heart and great arteries account for approximately 20% of all stillbirths and 30% of neonatal deaths. Fetal echocardiography is broadly defined as a detailed sonographic evaluation to identify and characterize fetal heart anomalies before delivery. To date, most forms of congenital structural heart disease are successfully diagnosed in utero, however it is not possible to detect every abnormality.

1. Fetal Echocardiography
Introduction
Congenital heart disease is a leading cause of infant morbidity and
mortality from birth defects with an estimated incidence of 6 per 1000
live births. Abnormalities of the heart and great arteries account for
approximately 20% of all stillbirths and 30% of neonatal deaths. Fetal
echocardiography is broadly defined as a detailed sonographic
evaluation to identify and characterize fetal heart anomalies before
delivery. To date, most forms of congenital structural heart disease are
successfully diagnosed in utero, however it is not possible to detect
every abnormality.
Indications
Maternal Indications
• Autoimmune antibodies, anti-Ro (SSA)/anti-La (SSB)
• Familial inherited disorders (eg, 22q11.2 deletion syndrome)
• Family history of CHD
• In vitro fertilization
• Metabolic disease (eg, diabetes mellitus and phenylketonuria)
• Teratogen exposure (eg, retinoids and lithium)
• Exposure to prostaglandin synthetase inhibitors (eg, ibuprofen,
salicylic acid, indomethacin)
• Familial inherited disorders (Ellisvan Creveld, Marfan, Noonan’s)
Fetal Indications
• Abnormal cardiac screening examination
• First-degree relative of a fetus with congenital heart disease

2. • Abnormal heart rate or rhythm
• Fetal chromosomal anomaly
• Extracardiac anomaly
• Hydrops
• Increased nuchal translucency
• Monochorionic twins
General Considerations
Fetal echocardiography is commonly performed between 18 and 22
weeks’ gestational age.
Technical limitations (eg, maternal obesity, prone fetal position and late
gestation) may warrant for repeat fetal evaluation
Basic Approach
Sequential segmental analysis of 3 basic areas that include the atria,
ventricles, and great arteries and their connections.
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