A suspicious scan result — what happens next?
A pregnant woman walks out of a routine ultrasound: "There's something with the heart — we're referring you for fetal echocardiography." There's no way to be prepared for that sentence. Your heart speeds up, questions start. What is this? How serious? What do we do?
This article is for that moment. I'll explain what fetal echocardiography is, why it's needed, what it shows, and what happens after you have the results.
Fetal echocardiography — what is it?
Fetal echocardiography (fetal echo) is a detailed ultrasound examination of the baby's heart in the womb. Unlike a standard obstetric scan, this examination focuses exclusively on the heart: the size of the chambers, the condition of the septa, the function of the valves, the position of the great vessels, and the direction of blood flow.
The examination is performed by a doctor specialising in the fetal heart — a fetal cardiologist. A session takes between 30 minutes and one hour, is easily carried out, painless, and causes no harm to the mother or the baby. Ultrasound technology has been in wide use for decades and its safety is thoroughly established.
The examination is typically performed between weeks 18 and 24 of pregnancy — by this point the baby's heart is large enough for detailed evaluation. In some cases an earlier examination is possible at 14–16 weeks via transvaginal access.
How it differs from a standard scan
A standard obstetric ultrasound scans all organs quickly — the heart passes through only a few standard planes. This is sufficient for detecting major abnormalities, but not for evaluating the fine structure of the heart.
Fetal echo is a full protocol dedicated to the heart alone: dozens of imaging planes, Doppler blood flow measurements, individual analysis of every chamber, every valve, every great vessel. Fetal echo sees roughly ten times more detail than a standard scan.
This is why, when a standard scan raises suspicion, fetal echo is the standard next step — to either confirm or rule out that suspicion. A referral does not mean "a problem was found." It means "let's look more carefully."
Who is referred for fetal echo
There are several main indications for fetal echo. Having one of them makes the examination recommended — but the examination itself does not confirm a problem in advance.
Suspected cardiac anomaly on standard scan. The most common reason for referral. A sonographer saying "something with the heart" is not yet a diagnosis — it is a signal to look more closely.
Diabetes in the mother. Particularly poorly controlled diabetes in the first trimester, which raises the risk of fetal heart anomalies.
Family history of heart defects. If one of the parents or a previous child has a heart defect, fetal echo is recommended in subsequent pregnancies.
Suspected chromosomal anomaly. A positive result on prenatal Down syndrome screening or other chromosomal abnormalities — since the majority of these syndromes are accompanied by heart defects.
Exposure to certain medications or infections in the first trimester. Rubella, certain anticonvulsant drugs, or other teratogenic substances.
Suspected fetal arrhythmia. An irregular heart rhythm in the baby noticed on a standard scan.
Extracardiac anomalies. Developmental anomalies in other organs — since some syndromes involve a heart defect alongside them.
How the examination is performed
Fetal echo is done in the same way as a standard ultrasound — warm gel is applied to the abdomen and an ultrasound probe is placed on the skin. The examination is painless. No special preparation is usually required — sometimes eating before the examination is recommended to make the baby more active; your doctor will advise you specifically.
During the examination the doctor obtains images of the heart from multiple planes. You will be able to see the baby's heartbeat on the screen in real time. The doctor may explain what they are seeing as they go — but the full report is given after the examination.
The duration ranges from 30 minutes to one hour. Depending on the baby's position, some images may be harder to obtain — in that case the doctor may ask you to change position.
What the result can show
The result of fetal echo will be one of three things.
Normal. The heart structure has formed correctly, everything is appropriate for the gestational age. This is the most common result — the majority of pregnant women referred for fetal echo receive a normal result. This does not mean the referral was unnecessary — a normal result after such an examination is a great relief.
Uncertain finding. In some cases the examination raises questions but does not provide enough information for a diagnosis. A repeat examination a few weeks later is usually recommended — as the baby grows the heart becomes better visible.
Identified anomaly. A specific defect has been found. This does not change everything in itself — it is not a catastrophe, it is information. And information gives an opportunity to prepare.
If a defect is found — what happens next
Prenatal diagnosis — meaning the identification of a heart defect before birth — significantly improves treatment outcomes. This is not just a phrase — it is a clinical fact.
The delivery of children with a prenatal diagnosis is planned: which hospital, which team, which equipment. From the first minute of the child's life, cardiac care is ready. In critical defects the first hours can be decisive — being prepared for them makes an enormous difference.
After receiving the fetal echo result, a consultation with a paediatric cardiologist and cardiac surgeon is usually arranged. At this consultation the nature of the defect, the expected development, and possible interventions after birth are discussed. Write down your questions in advance — there is a great deal you can ask at this meeting.
I want to say this clearly: a prenatal diagnosis does not amplify fear. It gives you time — to prepare, to learn, to build a relationship with the right team. That time can be used well.
What fetal echo cannot show
In the spirit of honesty, this needs to be said. Fetal echocardiography is a very powerful tool — but not a perfect one.
Some defects only become fully clear after birth — because circulation in the womb differs from postnatal circulation, and some anomalies only manifest clinically at the moment of that transition. The baby's position, the mother's body type, the volume of amniotic fluid — all of these affect image quality.
A normal fetal echo result is therefore not a 100% guarantee. But it is the most detailed assessment currently available. And when an anomaly is identified, it is the most important tool for preparation before birth.
How to prepare for the examination
The practical preparation is simple. Sometimes eating before the examination is recommended so the baby is active — your doctor will tell you specifically. No special diet or procedures are required.
The emotional preparation matters more. Don't go to the examination alone — bring your partner, your mother, or someone who supports you. Write down your questions beforehand: what defect exactly is suspected, what they are looking for, when the report will be ready.
During the examination, try to stay calm — it makes things easier for both you and the doctor. Ask about anything you don't understand. No question is a stupid one.
After the examination, you may need time to absorb and process the result. That is completely normal. Not all questions will be answered at once — that is part of this process. We are with you at every stage.