Advances in the UK fetal anomaly screening programme over the past 30 years have seen a progressive increase in congenital heart disease detected before birth For children undergoing surgery over the first year of life, approximately 60% now have an antenatal diagnosis.

The majority of patients referred with a suspected abnormality will be referred from their local units following an abnormality suspected during the NHS England Fetal Anomaly Screening Programme (FASP). This includes a cardiac protocol with 5 five key transverse views of the abdomen and chest that should be obtained during obstetric anomaly scans. 2015-2016 FASP standards. Patients may also be referred earlier in pregnancy if a problem is identified at their 12 week dating scan or if a scan performed for another indication suggests a cardiac problem or increased risk of CHD.

These patients are seen and managed in a fetal cardiology service that is offered at all tertiary cardiac centres. In some cases this is located in the cardiac unit, in others collocated in fetal medicine units but linked to the cardiac centre. The role is to provide rapid diagnosis and assessment of patients with suspected congenital heart disease identified during pregnancy. Parents are then provided with information on the diagnosis, prognosis and treatment options after birth. Additional support is provided by fetal specialist nurses. There is close collaboration with fetal medicine and obstetric services. Patients are made aware of prenatal testing options and pregnancy options. In some cases fetal cardiology clinics are collocated with local fetal medicine units.

Closer to the time of delivery a timing, mode and location of delivery is determined on the basis of the congenital heart defect and other maternal factors. Close collaboration with local neonatal services allows for a smooth transition of babies with a prenatal diagnosis through to neonatal services and postnatal cardiac management.

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

Detailed fetal echocardiogram is also performed for patients at increased risk of congenital heart disease during pregnancy.

There are two quality metrics in fetal cardiology that are returned to NHSE

1.    The proportion of patients with suspected abnormality seen within three calendar days

2.    The proportion of patients with fetal CHD contacted by the cardiac nurse on the day of diagnosis