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Early Fetal Echocardiography Program

ultrasound exam during the first trimester of pregnancy

The experts of the Johns Hopkins Center for Fetal Therapy are specially trained in early fetal echocardiography (echo). This specialized ultrasound procedure can diagnose fetal heart conditions as early as 11 weeks, giving families the opportunity to explore the available treatment options — including prenatal surgery — as early as possible and potentially allowing the best start for babies with heart disease.

Fetal Echo in Early Pregnancy at Johns Hopkins: Beyond Cardiac Care

  • Our holistic diagnostic approach looks at the whole baby, not just the heart. Over our many years caring for women with high-risk pregnancies, we have learned that congenital heart disease (heart disease that develops before birth) can be associated with other health problems, such as genetic and growth disorders. Thus, we perform a comprehensive evaluation of our patients, including genetic testing of the baby and the whole family, to better understand the full scope of your baby’s condition. Early diagnosis allows for early management to prevent potential complications.
  • We tailor the screening process to the individual patient. There is no one-size-fits-all screening protocol. Instead, we develop unique screening recommendations based on your medical history, current medical conditions and prior diagnostic test results. This custom screening approach allows us to recommend the best treatment approach for each patient.
  • We are skilled surgeons who treat a wide range of prenatal conditions before birth. We have extensive experience managing high-risk pregnancies and specialize in diagnosing and treating a wide range of fetal conditions. If your baby is found to have other prenatal conditions — such as congenital diaphragmatic hernia, spina bifida or complications of monochorionic twins — and surgery is recommended, you can trust our skilled surgeons to safely perform the most advanced fetal therapy procedures.
  • We bring experts from many specialties at Johns Hopkins to you, including genetic counselors, maternal-fetal medicine specialists, pediatric cardiologists, pediatric surgeons, neonatologists and all of the resources of the Johns Hopkins Children’s Center. We collaborate with our colleagues to provide expert care from your diagnosis to prenatal treatment, through delivery and childhood care.

Why might I need a fetal echocardiogram in my first trimester?

Traditional fetal echo is performed in pregnancies at around 20 weeks, when the fetal heart is about the size of a quarter. A first-trimester fetal echo is performed much earlier — in pregnancies between 11- and 14-weeks — when the fetal heart is about the size of a pea. These early scans are especially important for women who may be at a higher risk for having a baby with heart disease. With special equipment and training, we can diagnose the majority of major cardiac disease in the first trimester.

We recommend early fetal echo in various scenarios, including:

  • Following abnormal results of a first-trimester nuchal translucency screening such as differences in fetal heart rate, change in the positioning of the heart, or variations in blood flow
  • Preexisting maternal diabetes, especially if the hemoglobin A1c is greater than 7.5
  • Family history of congenital heart disease, including prior child or mother with heart disease
  • Conception through in vitro fertilization
  • Complications in identical twins

What are the benefits of fetal echocardiogram in early pregnancy?

Earlier diagnosis gives families the most treatment options. When caught early, some forms of congenital heart disease can be treated in utero, including:

At Johns Hopkins, our comprehensive screening process also provides information about the overall health of the baby, which can help prepare families for their child’s condition.

Fetal Echo in Early Pregnancy at Johns Hopkins: What to Expect

You will first meet with our team of experts at the Center for Fetal Therapy who will perform a detailed evaluation — including a fetal echocardiogram and genetic counseling — to diagnose potential heart disease and assess your risk for other conditions and complications. We will also review your medical history, current medical conditions and prior test results.

We will then meet with you to review these results and counsel you on your treatment options. If you are a good candidate for the fetal interventions above, we will provide further details about the procedure. The goal of fetal intervention is to prevent further damage to the heart and improve blood circulation. Performing these surgeries before birth may lower the risk for major surgery after birth and increase your baby’s chance of survival.

Once we develop your treatment plan, we will coordinate your care for the remainder of your pregnancy and set up any other consultation services needed. This includes connecting you with our colleagues in pediatric cardiology and pediatric surgery who will provide cardiac-specific care after birth.

We will closely monitor your pregnancy for any signs of complications that may require immediate care.

Meet Your Care Team

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