Pregnancy is a time of joy, anticipation, and careful monitoring of your baby’s development. With advanced prenatal imaging techniques available today, expecting parents are better equipped than ever to detect and manage potential health issues early on. One of the most commonly performed prenatal scans is the anomaly scan—a detailed ultrasound conducted around 18–22 weeks of pregnancy. But what happens when this scan appears normal? Do you still need a fetal echocardiogram (fetal echo)?
Let’s explore why some pregnant individuals are advised to undergo a fetal echo even after a normal anomaly scan, and what it means for your baby’s heart health.
What Is an Anomaly Scan?
The anomaly scan, also known as the mid-pregnancy scan or level 2 ultrasound, is typically done between 18 and 22 weeks of gestation. This scan checks the baby’s:
Organs (brain, heart, kidneys, liver, spine)
Limbs and skeletal structure
Face
Placenta and amniotic fluid
It helps detect structural abnormalities, including neural tube defects, cleft lip, and congenital heart defects.
Limitations of the Anomaly Scan
While comprehensive, the anomaly scan has certain limitations:
The fetal heart is small and beats very fast, making it harder to evaluate complex cardiac structures in a routine scan.
Operator expertise and equipment quality play a major role in the accuracy.
Subtle heart abnormalities or rhythm issues may be missed.
What Is a Fetal Echocardiogram?
A fetal echocardiogram is a specialized ultrasound that focuses solely on your baby’s heart. It is typically done between 18 and 24 weeks and provides a detailed view of:
Heart chambers and valves
Blood flow through the heart and major vessels
Heart rhythm and rate
Any structural or functional abnormalities
This test is non-invasive, safe, and painless—just like a regular ultrasound—but requires a pediatric cardiologist or a trained fetal medicine specialist for accurate interpretation.
Why Would You Need a Fetal Echo After a Normal Anomaly Scan?
Here’s the key point: a normal anomaly scan does not guarantee a structurally normal heart. The fetal heart is incredibly complex, and in some cases, specific risk factors or concerns may prompt your obstetrician to order a fetal echo.
Let’s break down the most common reasons why a fetal echo might still be needed:
1. Family History of Heart Defects
If you, your partner, or a close relative has a congenital heart defect, your unborn baby may be at a higher risk—even if the anomaly scan seems fine. A fetal echo helps rule out any similar conditions in your child.
2. Maternal Health Conditions
Certain maternal illnesses are linked to a higher risk of fetal heart problems:
Diabetes (Type 1 or 2, even gestational diabetes)
Autoimmune diseases (e.g., lupus or Sjögren’s syndrome with anti-Ro/SSA antibodies)
Congenital infections (like rubella or cytomegalovirus)
These conditions may warrant a fetal echo regardless of anomaly scan results.
3. Use of Certain Medications During Pregnancy
Some medications taken during pregnancy are associated with an increased risk of congenital heart defects, including:
Anti-epileptic drugs (valproate, carbamazepine)
Lithium (used in bipolar disorder)
Isotretinoin (used for acne, though contraindicated in pregnancy)
SSRIs (used for depression)
Your doctor may advise a fetal echo to ensure the baby’s heart has developed normally.
4. Abnormal Findings in Routine Scans
Even if the anomaly scan appears generally normal, some soft markers or subtle signs may raise suspicion:
Mildly abnormal heart views
Unexplained fluid accumulation (hydrops fetalis)
Increased nuchal translucency in first-trimester scan
Abnormal cardiac axis
These red flags may not always indicate a heart defect but require further evaluation.
5. Chromosomal Abnormalities or Genetic Conditions
If your baby has been identified (via NIPT, CVS, or amniocentesis) to have conditions like:
Turner Syndrome
Noonan Syndrome
…then a fetal echocardiogram is usually recommended, as these are often associated with heart issues.
6. Twin or Higher-Order Pregnancies
Twins and multiple pregnancies, particularly monochorionic twins (sharing one placenta), have a higher risk of:
Twin-to-Twin Transfusion Syndrome (TTTS)
Unequal blood flow
Structural anomalies
A fetal echo provides reassurance or helps plan early intervention.
7. In-Vitro Fertilization (IVF) Pregnancies
Studies suggest that IVF pregnancies may carry a slightly higher risk of congenital heart disease compared to natural conceptions. A fetal echo is a precautionary measure in these cases, even after a reassuring anomaly scan.
8. Maternal Exposure to Infections
Exposure to certain infections during early pregnancy can impact fetal heart development. These include:
Rubella
Cytomegalovirus (CMV)
Toxoplasmosis
Zika virus
Parvovirus B19
What Can a Fetal Echo Detect That a Normal Anomaly Scan Might Miss?
Some specific and critical heart conditions may be missed or incompletely evaluated on a routine scan, such as:
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Tetralogy of Fallot (TOF)
Transposition of the Great Arteries (TGA)
Hypoplastic Left Heart Syndrome
Arrhythmias or conduction issues
These can significantly affect a baby’s health and often require early postnatal surgery or medical care.
Benefits of Early Detection via Fetal Echo
Planning Delivery: In some cases, babies with heart defects are delivered in specialized centers with neonatal cardiac support.
Avoiding Birth Complications: Early diagnosis helps avoid delays in treatment after birth.
Parental Counseling: Helps families prepare mentally and emotionally.
Improved Outcomes: When congenital heart disease is diagnosed prenatally, outcomes are often better due to early planning and care.
What Happens During a Fetal Echo?
Duration: 30 to 60 minutes
Procedure:
Conducted using a high-frequency ultrasound probe
Gel is applied to the abdomen
Images of the baby’s heart are captured in real-time
No radiation involved
It’s completely safe for both mother and baby.
Do You Need to Prepare for a Fetal Echo?
No special preparation is required. However:
Eat a light meal beforehand
Bring previous scan reports
Wear comfortable clothing
Ensure you’re well-hydrated for clearer imaging
Who Performs a Fetal Echocardiogram?
It should be done by a trained:
Fetal Medicine Specialist
Pediatric Cardiologist
Radiologist with expertise in fetal echocardiography
At Sparsh Diagnostic Centre, our expert team ensures the highest accuracy using state-of-the-art ultrasound technology.
What If the Fetal Echo Is Normal?
That’s great news! A normal fetal echo brings reassurance and peace of mind. No further cardiac evaluations are typically needed unless other risk factors or symptoms emerge later in pregnancy.
Common Myths About Fetal Echo
| Myth | Fact |
|---|---|
| “It’s only needed if the anomaly scan is abnormal.” | Not true. Risk factors can exist even if scans appear normal. |
| “It’s dangerous for the baby.” | Fetal echo uses sound waves, not radiation—completely safe. |
| “Only older mothers need it.” | Age is one factor, but diabetes, family history, and medications matter too. |
When Should You Talk to Your Doctor?
Bring up fetal echo if:
You have any of the above-listed risk factors
You’re unsure if your anomaly scan was comprehensive
You’re carrying twins or had fertility treatments
Your doctor mentions “follow-up cardiac views” in your scan report
While a normal anomaly scan is incredibly reassuring, it may not tell the full story when it comes to your baby’s heart. If your doctor recommends a fetal echocardiogram, it’s not a cause for alarm—it’s a step toward ensuring your baby is as healthy as possible.
Timely fetal cardiac screening can mean the difference between a manageable condition and an emergency. So even with a normal anomaly scan, don’t skip the fetal echo if recommended.
Why Choose Sparsh Diagnostic Centre for Fetal Echo?
High-resolution fetal ultrasound equipment
Trained pediatric cardiologists and fetal medicine experts
Compassionate care and clear reporting
Quick appointments and fast results
🕘 Timings: Mon–Sat: 7 AM to 9 PM | Sunday: 7 AM to 3 PM
📍 Conveniently located in Kolkata
📞 Call: 9830117733 / 8335049501
🌐 Visit: www.sparshdiagnostica.com
Stay Informed. Stay Healthy. 💙
#BhaloTheko
Disclaimer:
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
