Congenital heart conditions are the most common structural difference in babies, affecting about 8 in every 1,000 births. Many are minor and close or need no treatment; around a quarter are critical and need care in the first weeks of life. Finding a significant heart condition before birth allows delivery to be planned where the right paediatric cardiology and neonatal support is available.
A fetal echocardiogram goes further than the heart views taken at the routine anomaly scan. It examines each chamber, valve and major vessel in sequence, uses colour Doppler to follow blood flow, and studies the heart rhythm. It is usually done between 18 and 24 weeks, and an early heart scan from around 13 to 16 weeks is possible in selected high-risk pregnancies.
Fetal echocardiography is part of the fetal medicine service of Dr. Devang Patel at Divine Women’s Hospital, Gota. The heart is interpreted alongside the rest of the baby’s anatomy, genetic results and your medical history, so you get one joined-up plan rather than separate reports.
Why some babies need a dedicated heart scan
The baby’s heart forms between about 3 and 8 weeks after conception. Anything that affects development at that stage, such as high blood sugar, some medicines, inherited factors or chromosomal conditions, can raise the chance of a heart defect.
Most babies with heart defects, around 9 in 10, are born to parents with no risk factors at all, which is why every anomaly scan includes heart views. A fetal echo is added when the chance is higher, or when the routine views raise a question. It is a targeted test, not a routine one for every pregnancy.
Who is advised to have a fetal echo
- Diabetes present before pregnancy, or HbA1c above about 6.5% in early pregnancy
- Pregnancy conceived through IVF or ICSI
- A parent or previous child with a congenital heart condition (the chance rises to roughly 2–5%)
- Nuchal translucency of 3.5 mm or more, or abnormal ductus venosus or tricuspid flow at the NT scan
- Heart views at the anomaly scan that could not be confirmed as normal
- Monochorionic twins, and especially twin-to-twin transfusion syndrome
- Anti-Ro or anti-La antibodies, as in lupus or Sjögren’s syndrome, because of the risk of heart block
- Medicines in early pregnancy such as valproate, lithium, isotretinoin or high-dose retinoids
- A fast, slow or irregular heartbeat, hydrops, or another structural or chromosomal finding in the baby
- Parents who are blood relatives (consanguinity)
What the echo examines
The scan follows a set sequence: the position of the heart in the chest, the four chambers and the walls between them, the mitral and tricuspid valves, and the two great arteries, the aorta and the pulmonary artery, as they leave the heart and cross. The three-vessel and trachea view, the arch views and the veins returning to the heart complete the structural survey.
Colour and pulsed Doppler show whether blood is flowing in the right direction and at the expected speed through each valve. M-mode and Doppler recordings are used to study the rhythm, and in babies of mothers with anti-Ro antibodies, the timing between the upper and lower chambers (the PR interval) is measured.
Common heart conditions and what they mean
Heart conditions range from small holes that close on their own to complex conditions needing surgery soon after birth. The table gives a simplified overview of some of the more common ones found before birth.
| Condition | What it is | Usual outlook and plan |
|---|---|---|
| Ventricular septal defect (VSD) | Hole between the lower chambers | Small ones often close; larger ones may need surgery in infancy |
| Atrioventricular septal defect | Central hole with a shared valve | Surgery in infancy; linked with Down syndrome, so genetic testing is offered |
| Tetralogy of Fallot | VSD with narrowing of the pulmonary outflow | Surgical repair, usually in the first year |
| Transposition of the great arteries | Aorta and pulmonary artery swapped | Needs delivery at a cardiac centre and early surgery |
| Coarctation of the aorta | Narrowing of the aortic arch | Suspected before birth; confirmed after; may need surgery |
| Hypoplastic left heart | Underdeveloped left side of the heart | Complex staged surgery; detailed counselling of all options |
Heart rhythm problems
Irregular beats are common in the womb and are usually harmless extra beats that settle on their own. They are checked with a fetal echo and followed with heart rate checks until they resolve.
A sustained fast rhythm (supraventricular tachycardia) can strain the heart and may be treated by giving medicine to the mother, which crosses the placenta. A very slow rhythm from complete heart block, usually linked to anti-Ro antibodies, is monitored closely, and delivery is planned with paediatric cardiology support.
If a heart condition is found
You will be told what the condition is, how it affects the circulation before and after birth, and how certain the diagnosis is. Because some heart conditions are linked to chromosomal differences such as Down syndrome or 22q11 deletion, amniocentesis with microarray is usually offered. Follow-up echoes track how the heart develops, often at 28 to 32 weeks and again before delivery.
For conditions that need care soon after birth, delivery is planned at a hospital with a paediatric cardiac surgery team. For minor conditions, the plan is usually reassurance and an echocardiogram for the baby after birth. Most babies with heart conditions can be born vaginally; the heart condition alone is rarely a reason for caesarean.
For couples facing a complex or severe condition, counselling covers all the options, the likely number of operations and the long-term outlook, so that decisions are informed and unhurried.
Knowing about a critical heart condition before birth gives time to plan where and how the baby is delivered.
Limits of fetal echocardiography
Some heart conditions cannot be seen before birth. Very small VSDs may not be visible, and the foramen ovale and ductus arteriosus are normal openings in every baby in the womb, so problems related to them (such as an ASD or PDA) can only be judged after birth. Coarctation can be suspected but sometimes only confirmed after delivery.
Image quality also depends on the baby’s position, your body build and the amount of fluid. A repeat scan is sometimes needed to complete the views.
Future pregnancies and how care is organised
After a baby with a congenital heart condition, the chance of a heart condition in the next baby is roughly 2 to 3%, higher if more than one family member is affected or a genetic cause is found. In the next pregnancy, folic acid before conception, good control of any diabetes, an early heart scan at 13–16 weeks and a full fetal echo at 18–22 weeks are usually advised.
At Divine Women’s Hospital, Gota, the fetal echo is performed by Dr. Devang Patel as part of your fetal medicine care, and the findings are linked to the NT, anomaly scan and any genetic result. Where a significant heart condition is confirmed, referral to a paediatric cardiologist and, when needed, a cardiac surgical centre in Ahmedabad is arranged, and the birth plan is written down with you in Gujarati, Hindi or English.
If the baby needs no special care, delivery can take place at Divine Women’s Hospital with 24×7 labour care and neonatal support, and the baby’s heart is checked again after birth.
A note on the PCPNDT Act
Pre-natal sex determination is prohibited in India under the PCPNDT Act. The sex of the baby is not detected or disclosed at any scan.
Your care, step by step
- Referral reviewThe reason for the echo and earlier scan reports, sugar control and medicines are reviewed beforehand.
- Detailed heart scanStructure, blood flow and rhythm are assessed in sequence, usually over 30 to 60 minutes.
- DiscussionFindings are explained with diagrams, including what they mean for the baby after birth.
- Genetic and specialist inputGenetic testing and a paediatric cardiology consultation are arranged where the finding calls for it.
- Follow-up and birth planRepeat echoes, the place of delivery and the newborn heart check are planned in advance.
When to book a visit
- You have pre-existing diabetes, or conceived through IVF or ICSI
- You, your partner or a previous child has a congenital heart condition
- Your NT was 3.5 mm or more
- The anomaly scan could not confirm the heart views as normal
- You have anti-Ro or anti-La antibodies, or the baby’s heartbeat is irregular
- You took medicines such as valproate or lithium in early pregnancy
Warning signs - get same-day care
- A clear reduction or change in the baby’s movements after 24 weeks
- A rapidly growing bump with breathlessness, which may mean excess fluid
- Vaginal bleeding or leaking of fluid
- Severe headache, blurred vision or upper abdominal pain
- Fever above 38 °C or feeling very unwell
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: A normal anomaly scan means the heart is definitely normal.
Routine heart views detect many but not all serious defects. A fetal echo is more detailed when the chance is higher.
Myth: A heart defect means the baby will not survive.
Most congenital heart conditions are treatable, and many children grow up to lead normal lives after surgery or with no treatment at all.
Myth: A baby with a heart condition must be delivered by caesarean.
Most can be born vaginally. Planning focuses on where the baby is born, not usually on the mode of birth.
Myth: Heart defects are caused by something the mother did, such as lifting or stress.
Most heart defects have no identifiable cause and are not linked to work, travel, stress or diet. Known risks such as uncontrolled diabetes are the exception.
Frequently asked questions
When should fetal echocardiography be done?
Usually between 18 and 24 weeks. In high-risk pregnancies, an early heart scan from about 13 to 16 weeks can be done, followed by a full echo later.
Is fetal echo different from the anomaly scan?
Yes. The anomaly scan includes standard heart views as part of a whole-body check. A fetal echo is a dedicated, longer examination of the heart, with more views and detailed Doppler of flow and rhythm.
Can a fetal echo detect a hole in the heart?
Larger holes, such as many VSDs and AVSDs, can usually be seen. Very small holes may not be visible, and an ASD cannot be judged before birth because that opening is normally present in every baby.
Is fetal echocardiography safe?
Yes. It is an ultrasound scan through the abdomen with no radiation and no needle.
Why is fetal echo advised after IVF?
Babies conceived through IVF or ICSI have a slightly higher chance of heart defects, roughly 1 to 1.5% compared with under 1% in the general population, so a dedicated heart scan is reasonable.
I have diabetes. Does good sugar control reduce the risk?
Yes. The chance of heart defects rises with HbA1c in early pregnancy. Good control before conception and in the first trimester lowers it, but a fetal echo is still advised.
What happens if the baby’s heartbeat is irregular?
Most irregular beats in the womb are harmless extra beats that settle. A fetal echo identifies the rhythm, and the few babies who need treatment are monitored closely with paediatric cardiology support.
Will my baby need tests after birth?
If a condition was suspected, the baby will have an echocardiogram after birth. Routine newborn checks, including pulse oximetry, also help pick up some heart conditions.
Can a heart problem seen on the scan go away?
Some can. Small muscular VSDs often close before or after birth, and mild valve leaks or a slightly prominent chamber can resolve on a later scan. Structural conditions such as transposition do not resolve and need planned care.
How should I prepare for a fetal echo?
No fasting or full bladder is needed. Bring your NT and anomaly scan reports, your latest HbA1c if you have diabetes, and a list of medicines. Wear loose clothing, and allow up to an hour in case the baby needs time to move into a better position.