Fetal Cardiology

Fetal cardiologists are paediatric cardiologists who specialise in the diagnosis and management of congenital heart disease (CHD) diagnosed during prenatal life. They work in close collaboration with obstetricians and fetal medicine specialists and have a pivotal role in training obstetric ultrasonographers to screen for CHD in low-risk pregnancies. Fetal heart sonographers specialise in imaging the heart and work alongside fetal cardiologists and fetal medicine specialists.

Fetal cardiology service is offered in all tertiary CHD centres and in some instances, it forms an integral part of a fetal medicine unit dealing with high-risk pregnancies. Although the service focuses on evaluation of the fetal heart in pregnancies judged to be at high risk for CHD or where a cardiac lesion is suspected from obstetric screening, the fetal cardiologist has a growing role in assessing the fetal heart in other high-risk pregnancies. Examples include pregnancies affected with extra-cardiac abnormalities, intra-uterine growth restriction, anaemia and twin-to-twin transfusion syndrome.

National Fetal Cardiology Working Group

This BCCA affiliated national working group promotes the study and care of women and their unborn child with congenital heart disease. The constitution and details on membership of this organisation can be found in the document here.

Education and Training

Training in this subspecialty is part of the curriculum of training in paediatric cardiology with the option of specific numbered training positions (NTNs) in fetal cardiology. The fetal cardiology NTN position is of one-year duration and is designed to equip the post holder to take up a consultant position within this subspecialty.

For fetal heart sonographers there is no official training program or accreditation exam. However, The Fetal Medicine Foundation is a Registered Charity that, with the support of an international group of experts, has introduced a free educational programme for healthcare professionals with a series of certificates of competence in different aspects of fetal medicine, including the fetal heart.

UK Guidelines

With regard to screening, in 2010 a national cardiac protocol was produced by the Department of Health Fetal Anomaly Screening Programme (FASP) and was revised in April 2015. The 2015-2016 FASP standards for the fetal heart relate to five key transverse views of the abdomen and chest that should be obtained during obstetric anomaly scans.

UK Audit

For live born children who undergo surgery or catheter intervention in infancy, NICOR (National Institute for Cardiovascular Outcomes Research) records the proportion of children in whom a prenatal diagnosis was made; this is publicly available online. Click here. 

Key documents and websites 

• BCCA Fetal Cardiology Standards (Revised September 2021)
• Fetal anomaly screening programme standards: 2015 to 2016
• AIUM Practice parameter for the performance of fetal echocardiography (2013)
• Diagnosis and Treatment of Fetal Cardiac Disease: A Scientific Statement from the American Heart Association (2014)
  
• American Society of Echocardiography Guidelines and Standards for Performance of the Foetal echocardiogram (2013)
• ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart Ultrasound Obstet Gynecol (2013)
• Evaluating the fetal heart: How do we improve? Kardio Prenatal (2013)
  
• JRCPTB curriculum for training in core and advanced fetal cardiology (2012)
  
• ISUOG Consensus statement (2008): What constitutes a fetal echocardiogram   
• Recommendation for the practice of fetal cardiology in Europe (2004)
• The Fetal Medicine Foundation Online Education
• NCHDA information on prenatal diagnosis of congenital heart disease in the UK