Provider News

Referral Indications for Fetal Echocardiograms: A Message From Dr. Bhawna Arya to Our Obstetric, Maternal Fetal Medicine and Fetal Cardiology Colleagues

July 5, 2023

Dr. Bhawna AryaDear Colleagues:

I wanted to share with you the hot-off-the-presses updated guidelines entitled “Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography” published in the Journal of the American Society of Echocardiography last month. The co-authors are experts in the field, and our own fetal cardiologist Dr. Nelangi Pinto is one of the co-authors.

This new document replaces the 2004 guidelines and is focused on referral indications for fetal echocardiogram and has been updated from the previous American Heart Association (AHA) guidelines from 2014.

There are several important changes to share and a summary created by our Seattle Children’s Fetal Cardiology team is included here along with the original guidelines paper. The highlights are that a fetal echocardiogram is no longer indicated (based on low risk <3%) if the cardiac views are visualized and normal on obstetric anatomy scan and the following are present in isolation:

  1. In vitro fertilization
  2. Nuchal translucency (NT) less than 3.0 (between 3.0 and 3.5 MAY consider fetal echo)
  3. Maternal lithium or anticonvulsant exposure
  4. Obesity (BMI >30)
  5. Single umbilical artery (two-vessel cord)

Of course, if any concerns are raised by your team or the patient for any reason from a fetal cardiac perspective, the Seattle Children’s Fetal Cardiology team throughout the WAMI region (Washington, Alaska, Montana Idaho) is always more than happy to perform a fetal echo and consult with the patient. Our goal is to provide the best fetal cardiology diagnosis, care and counseling to families and make sure that as providers, your team has all of your questions regarding the fetal heart answered, no matter what the indication.

I am attaching the new guidelines paper (Table 1 includes all of the indications for fetal echo) as well as our Seattle Children’s concise summary of indications. Please reach out with any questions or concerns.

Bhawna Arya, MD
Associate Professor | Department of Pediatrics
Director | Prenatal Diagnosis Program
Director | Fetal Cardiology
Director | Advanced Imaging Fellowship | Division of Pediatric Cardiology
University of Washington School of Medicine
Seattle Children’s Hospital, Heart Center and Fetal Care and Treatment Center

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