Screening in Pregnancy
 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.
IMAGE (above) an ultrasound profile of a
baby >>
Do you have a family history?
Every pregnancy has a small risk of congenital
heart disease and this risk increases slightly if there is a family
history.
If you or your partner have
congenital heart disease (CoHD), or have relatives with CoHD, or
have had a baby with CoHD, then you have a family history of
congenital heart disease.
If this is the case it is advisable for parents
to have a full "fetal echo" (described below) and not just a screening test.
When to screen the heart
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:
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 -
costing millions
2. Detecting congenital heart disease after a baby is born can be difficult and 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 (PO) in the newborn period, as this can
detect some babies with CoHD that were missed at "20-week"
screening and can be a cost-effective "safety-net"; however
PO is not a replacement for good antenatal
screening
Types
of scan
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.
More information
on Nuchals
...
 Note: There is a reported
association between a raised Nuchal Fold and about 1/3rd
of cases of congenital heart disease.
However, some babies with CoHD 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.
Link to "antenatal_testing: ultrasound_scans"
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.
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?
In over 2/3rds of cases (c. 70%), heart disease is
not
detected and these babies are born with undiagnosed heart
disease. (see Improving detection, below)
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.
Links
For more links visit our
Links and Support pages
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