Screening

Women will usually be offered a fetal anomly scan at around 18 to 20 weeks gestation and there may be an option of an early "fetal echo" at about 14 weeks.  Ask your GP or hospital for more information.

The growth of babies in the womb and the development of their organs can be checked using high-frequency sound waves ("ultrasound").  This is often performed by a sonographer (or midwife) and sometimes by an obstetrician or cardiologist.

An ultrasound screening scan is not invasive.  The result is based on what is seen and interpreted, but not all problems can be detected by ultrasound.

In most births (96%), no problems are found.  However, every pregnancy has a small risk of an anomaly, so screening is a important consideration in every pregnancy.

WHEN TO SCREEN THE HEART

Our recommendation

We recommend screening for congenital heart disease during pregnancy at the routine "20-week" ultrasound scan, using a "5 View protocol" that aims to improve the detection of most forms of heart disease.  This is because:

1. In the UK, there is no programme for giving an echocardiogram to babies after birth, so this would be very expensive to set up and need thousands of new machines and new people to do it

2. Detecting congenital heart disease after a baby is born can be difficult and heart disease may be life-threatening

3. There is already an extensive programme of scanning for congenital problems at around 20 weeks of pregnancy, so there is no need to create a new programme or find new resources - we can simply improve the current one, so this is very cost-effective

4. Detection before birth has many benefits - it allows better care of baby and mother before delivery, allows doctors to plan for a safer delivery in the right place at the right time

5. Finally, it is important to say that we support Pulse Oximetry in the newborn period, as this can detect some babies with CHD that were missed at "20-week" screening and can be a cost-effective safety-net, but it has certain limitations.
Read more about Pulse Oximetry - can it help heart babies.

Early ultrasound dating scan

In the UK, hospitals and clinics may offer an early dating scan at around 11-12 weeks' gestation to confirm the gestational age from measurements of a baby.  This may be combined with a Nuchal Translucency (NT) scan, at around 11-14 weeks' gestation and other tests to screen for Down's Syndrome.   

There is a reported association between a raised Nuchal Fold and about 1/3^rd of cases of congenital heart disease. However, some babies with CHD may have a normal Nuchal, so it is important to perform a routine anomaly scan at around 20 weeks' gestation. At 11-14 weeks' the developing heart is still very small and heart problems are more difficult to spot and may not have developed.

Screening at around 20 weeks

The routine 20-week ultrasound scan is often performed between 18-20 week's gestation and checks the organs of a growing baby.  This is also the best time to scan a baby's heart.  If congenital heart disease is present, it is usually much easier to detect at this time.

If you are about to have a screening scan - we think it is reasonable to ask about heart screening for your baby.

WHAT HAPPENS IF A PROBLEM IS SUSPECTED?

If a sonographer suspects a heart defect, they will usually refer parents to a specialist for a detailed scan, called a "fetal echo".  Usually an appointment will be made as soon as possible.

Many parents tell us that finding that there may be a problem with their baby's heart, following a scan, is a very tough and worrying time.

It is natural to want to do something and to find out as much as possible about a baby's heart condition.

However, heart disease is very complicated and the best advice is to "hold on" until you see a specialist, who can perform a "fetal echo" and give an individual diagnosis.

In some cases, the diagnosis will be reassuring, and in other cases there may be a serious heart problem.  Whatever the outcome, a specialist will be able to answer your questions and help you to plan the next steps.

It can also help to know what other parents have been through - see our experiences and support pages.

WHAT HAPPENS IF A HEART PROBLEM IS MISSED?

On average, only 1 heart baby in every 3 is detected and most heart babies are born with undiagnosed heart disease. Tiny Tickers is working to improve screening so that more heart babies are diagnosed before they are born.

Before birth, the developing heart and circulation is quite different from the heart.  At birth, the lungs inflate and the connection to the placenta is cut.  The lungs take over the job of supplying oxygen to the baby.

Over the next few days, the arterial duct ("duct") and oval foramen (FO) must close or reverse to allow normal adaptation.  If heart disease is present, this can be life threatening, so it is important to know the signs of undetected & undiagnosed heart disease after a baby is born - see Think HEART for more information.