Fetal heart experts working with the American Heart Association have developed guidelines to help healthcare providers care for unborn babies with heart problems, as well as their families.
With advanced imaging technologies, such as high-resolution ultrasound and three- and four-dimensional echocardiography, magnetic resonance imaging, fetal electrocardiography and magneto-cardiography has enabled physicians to diagnose fetal abnormalities early and with better detail and accuracy.
Still more than half of babies with congenital heart disease go undiagnosed before birth. To better manage these guidelines have been developed to provide pediatric cardiologists, obstetricians, maternal fetal specialists, radiologists, nurses and other healthcare providers with the latest developments in the rapidly developing area of fetal cardiology.
- Pregnant women with specific risk factors should be referred for fetal echocardiography, a technology that uses sound waves to examine the fetal heart. Women at risk include those who have had diabetes before pregnancy, diabetes diagnosed in the first trimester, have taken NSAIDs in their third trimester, have congenital heart disease or a close relative with congenital heart disease, or other specific maternal medical conditions, and possibly those who conceived with in vitro fertilization. Fetuses at risk include those identified with a chromosome problem or other abnormality, or those with a suspected heart problem. Fetuses diagnosed with a heart abnormality should be carefully monitored and healthcare providers should plan the delivery and post-delivery care that the baby will need.
- Some fetal heart rhythm disturbances or heart function abnormalities can be treated with medicines given to the mother, which cross the placenta to reach the fetus.In-utero heart catheterization and surgical procedures are being performed, however are still considered experimental.
The psychological effects and depression that may result when a pregnant woman and her family learns that their child has a congenital heart abnormality are also important factors for healthcare providers to consider. Parents often grieve upon learning that their unborn baby has a congenital heart condition.
Families should be provided information in an unbiased way, which not only addresses the condition and what’s involved in treatment, but also whether children will be able to play sports, do well in school, and what kind of support they might need, physically and mentally. In addition, health providers should help families overcome anxiety and depression, so they can transition from grief to acceptance and become active members of the team that care for the unborn baby.
Magnetic Resonance Imaging: An MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not use radiation (x-rays).
Fetal electrocardiography: The test is typically performed by a specially trained ultrasound sonographer. Perform in two ways: Abdominal ultrasound: most common form of ultrasound to evaluate the baby’s heart. Gel is applied to the mother’s abdomen, the ultrasound probe is gently placed on the mother’s abdomen and pictures are taken. This test is not painful and causes no harm to the baby. The test takes an average of 45–120 minutes depending on the complexity of the baby’s heart. Endovaginal ultrasound: is used early in pregnancy. A small ultrasound transducer is inserted into the vagina and rests against the back of the vagina. Pictures can then be taken of the baby’s heart.
Magnetocardiography (MCG): a technique to measure the magnetic fields produced by electrical activity in the heart using extremely sensitive devices such as the Superconducting Quantum Interference Device (SQUIDs). If the magnetic field is measured using a multichannel device, a map of the magnetic field is obtained over the chest; from such a map, using mathematical algorithms that take into account the conductivity structure of the torso, it is possible to locate the source of the activity. For example, sources of abnormal rhythms or arrhythmia, may be located using MCG.