Fetal Echocardiography

All Fetal Echocardiography Scans (Fetal Heart Scan) are performed by Dr Fred Ushakov, who is an internationally recognised expert and teacher in this field. Dr Fred’s mission is to empower ultrasound practitioners with ‘proper education in fetal echocardiography,’ aiming to boost the detection rate of CHD and thus ‘save many lives.’

He has organised, chaired and spoken at multiple conferences with London School of Ultrasound on the subject of Fetal Echo during the Annual EFScan Conferences.

At the London Pregnancy Clinic, “Fetal Heart Scan” and “Fetal Echocardiography” refer to the same procedure. The term “Fetal Heart Scan” is used to help expectant mothers understand that the scan is specifically focused on the heart, emphasising its specialised nature in assessing the baby’s heart health early in the pregnancy. This naming convention aims to make the purpose of the scan clearer and more relatable for mothers-to-be.

For you, fetal echocardiography will resemble a regular ultrasound scan. You will see your baby’s beating heart on our special screen and we will explain to you what structures we check.

In the majority of cases, we need to use both transabdominal and transvaginal approaches to get the best quality images of your baby’s heart. Understandably you can choose to avoid a transvaginal scan, however, in some cases the information regarding the baby’s heart will be incomplete or inaccurate without this examination.

We believe that the heart together with the brain is the most important part of the humans. Early Fetal Echocardiography has special focus on fetal heart, however we perform comprehensive top-to-toe examination of all structures for your baby.

Yes, of course. We use Tricefy which is a secure cloud system to upload images and clips from your baby’s heart scan to be viewed by your doctor.

Tricefy also allows you to download the images and clips of the heart and share them with your fetal medicine or obstetric consultant or fetal cardiologist. By your special request we can also directly share securely those images and clips with your doctor. For this you will need to provide his/her secure email address.

You will also receive a hard and soft copy of your detailed ultrasound and early fetal echocardiography report as well as some high-quality colour printouts of the baby for you to take home with you.

Yes, definitely. The website of the London School of Ultrasound associated with our clinic has its unique name fetalechocardiography.com. Not only are we internationally recognised experts in performing Early Fetal Echocardiography, but we also have a long-standing record of training this technique to professionals in the UK and around the world.

In the first trimester we can diagnose about 80% of severe heart defect which can be recognised prenatally (before birth).

We cannot diagnose isolated ventricular heart defects, progressive abnormal development of the valves and some other heart anomalies.

Generally yes, however it is still not considered an indication for Fetal Echocardiography in the UK.

American Institute of Ultrasound in Medicine (AIUM) in its Practice Parameter for the Performance of Fetal Echocardiography considers ‘greater-than-normal nuchal translucency measurement between 3.0 and 3.4 mm’ as an indication for Fetal Echo.

The most common indications for fetal echocardiography are situations where the baby has a higher-than-average chance of a heart problem. These include an increased nuchal translucency (NT) measurement, an inconclusive or abnormal heart view at the 11–13 week scan, a family history of congenital heart defects, maternal diabetes and certain medicines taken in pregnancy.

That said, most babies with heart defects are born to families with no known risk factors, so an early heart scan can be reassuring for any anxious parent. Our Early Fetal Echocardiography, performed by Dr Fred Ushakov, examines the heart in detail from about 12 weeks. If you are unsure whether the scan is right for you, our team is happy to talk it through before you book.

• increased nuchal translucency (NT) for the fetus
• inconclusive or abnormal heart scan by sonographer
• family history of heart defects
• maternal diabetes
• maternal medications

The difference is one of focus and depth. Our Early Fetal Scan is a comprehensive top-to-toe check of your baby’s early development. Early Fetal Echocardiography includes everything in that scan and then adds a specialised, detailed examination of the heart and the great vessels (the main connections that carry blood to and from the heart).

In other words, Early Fetal Echocardiography is the more in-depth option, combining both examinations in a single appointment:

• special comprehensive examination of the heart and great vessels (heart connections)
• Early Fetal Scan

No, unfortunately sometimes fetus stays in awkward position and we cannot get all the views of the heart. In those cases we will rescan you for free later in pregnancy (usually in 2 weeks time).

Yes, we can perform Early Fetal Echocardiography for every mother, who is anxious regarding normality of her baby’s heart.

Unfortunately, vast majority of heart defects are diagnosed in babies from low-risk families.

Cardiac anomalies occur very frequently. According to NHS portal congenital heart disease is one of the most common types of birth defect, affecting almost 1 in 100 babies born in the UK.

The British Heart Foundation notes that each day, around 13 babies in the UK are diagnosed with congenital heart disease.

Yes, even very healthy parents can have a baby with a severe heart defect. Congenital heart disease is the most common type of birth defect, affecting almost 1 in 100 babies born in the UK, and the majority of these babies are born into low-risk families with no history of heart problems. A healthy pregnancy does not rule out a heart anomaly.

This is exactly why an early heart check can be so reassuring. Our Early Fetal Echocardiography examines your baby’s heart in detail from around 12 weeks, so you do not have to wait until later in pregnancy for answers. If you would like to understand your own situation better, our specialists are happy to discuss your history before you book.

If we will diagnose fetal cardiac anomaly for your baby you will need to be counselled by Fetal/Paediatric Cardiologist. Fetal Medicine Units in different London hospitals have various arrangements for this type of consultations. We will assist you with referral for Fetal Cardiologist.

There are many different types of congenital heart abnormality, ranging from minor to severe.

According to the CDC: About 1 in every 4 babies born with a heart defect has a critical congenital heart defect (critical CHD, also known as critical congenital heart disease). Babies with a critical CHD need surgery or other procedures in the first year of life.

There is new (2022) publication from Oxford researchers by Dr Karim and other. It is called ‘First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis’.

Here is the link for this excellent scientific paper: Karim, et al, 2022

Hole in the heart (ventricular septal defect or VSD) is very common anomaly. Small VSDs usually not recognised before birth. Usually this type of cardiac anomalies have good outcome (majority close spontaneously)

Early Fetal Echocardiography cannot diagnose isolated VSDs.

Yes, an early scan can detect many severe heart anomalies — studies report that a first-trimester scan detects roughly 55–60% of major heart defects in routine (low-risk) pregnancies and around two-thirds (about 68%) in higher-risk pregnancies (Karim et al., 2022). It is a screening test, not a diagnostic one, so a normal result is very reassuring but cannot fully exclude every heart defect; some develop or only become visible later in pregnancy.

We are so sorry for the loss of your previous pregnancy, and it is completely understandable to feel anxious this time. You can book your Early Fetal Echocardiography from around 12 weeks, which is the earliest point at which we can examine your baby’s heart in reliable detail. Because your history places you at higher risk, this scan is well suited to your situation.

To get the clearest possible views of your baby’s heart this early, we will usually recommend a transvaginal (internal) scan alongside the abdominal scan. A normal result offers early reassurance, though no scan can exclude every heart condition entirely. If you would like personal advice or support before then, please contact us and our specialists will guide you through your options.

Yes, you can have Early Fetal Echocardiography together with NIPT. Because both look at your baby’s wellbeing in the first trimester, many parents choose to combine them. NIPT is a simple blood test that screens for common chromosomal conditions such as Down’s syndrome, while the echo examines the structure of the heart — the two give complementary information.

We offer NIPT as an add-on to your scan appointment, so a single visit can cover both. As NIPT prices depend on the panel you choose, please contact us and our team will explain the current options and what each test includes, so you can decide what is right for you.

Yes, if you have already booked your Early Fetal Echo you can add NIPT to the same appointment. This means one visit gives you both a detailed look at your baby’s heart and a screening blood test for common chromosomal conditions, which many parents find convenient and reassuring.

Simply let our team know in advance that you would like NIPT added, so we can prepare and arrange the blood sample on the day. Because pricing depends on the NIPT panel you select, please contact us beforehand and we will confirm the current cost and what is included.

Yes, if something unusual was noted at your 11–13 week scan, Early Fetal Echocardiography can be a very worthwhile next step. Inconclusive or abnormal findings at this stage — such as an increased nuchal translucency measurement or other unexpected features — are commonly associated with heart anomalies, so a detailed look at the heart is sensible.

Our Early Fetal Echocardiography examines the heart and great vessels in depth from around 12 weeks and, in most cases, gives you answers far sooner than waiting for the routine 20-week scan. If you are unsure whether the finding warrants an early echo, contact us with your scan details and our specialists will advise you.

According to the British Heart Foundation, the commonest congenital heart defects are:

Aortic stenosis

Atrial septal defect

Coarctation of the aorta

Common arterial trunk

Complete and partial atrioventricular septal defect

Double inlet ventricle

Hypoplastic left heart

Large ventricular septal defect

Patent ductus arteriosus

Pulmonary atresia with intact ventricular septum

Pulmonary atresia with ventricular septal defect

Pulmonary stenosis

Supraventricular tachycardia

Tetralogy of Fallot

Transposition of the great arteries

Tricuspid atresia

• Aortic stenosis
• Atrial septal defect
• Coarctation of the aorta
• Common arterial trunk
• Complete and partial atrioventricular septal defect
• Double inlet ventricle
• Hypoplastic left heart
• Large ventricular septal defect
• Patent ductus arteriosus
• Pulmonary atresia with intact ventricular septum
• Pulmonary atresia with ventricular septal defect
• Pulmonary stenosis
• Supraventricular tachycardia
• Tetralogy of Fallot
• Transposition of the great arteries
• Tricuspid atresia

Yes, Early Fetal Echocardiography is considered very safe. It uses diagnostic ultrasound, which has an excellent safety record with no known harmful effects at the levels used for medical scanning. The same technology is used routinely in NHS pregnancy care, and there is no radiation involved.

At the London Pregnancy Clinic, every echo is carried out by Dr Fred Ushakov using established, safety-conscious scanning practice. Where the clearest heart views require it, we may use a transvaginal (internal) scan, which is also safe in pregnancy. If you have any concerns about the scan, please ask us and we will explain exactly what to expect.

Early Fetal Echocardiography is the most expensive ultrasound scan. It is because of:

The highest level of expertise required from the doctor performing the echo

Use of the most advanced ultrasound scanner and a range of transducers (we use five different types)

It is a time-consuming examination

• Need for highest level of expertise of the doctor, who performs Echo
• Use of the most advanced and expensive ultrasound scanner and various transducers (we have 5 different types of transducers)
• It is time consuming ultrasound scan

Yes, we perform Early Fetal Echocardiography for twins. Each baby’s heart is examined individually, so both receive the same detailed assessment of the heart and great vessels. Because twin pregnancies can carry a slightly higher chance of certain complications, many parents of twins find this early heart check especially reassuring.

A twin echo naturally takes a little longer, as there are two babies to image carefully. Please contact us to arrange your appointment so we can allow enough time, and our team will confirm the details and answer any questions you have beforehand.

Yes, up to half of the babies with Down’s syndrome have heart defects. The most common cardiac anomaly for fetuses with trisomy 21 (T21) is atrioventricular septal defect (AVSD) or hole in the middle of the heart.

No, you do not need a full bladder for Early Fetal Echocardiography. In fact, a full bladder can push the uterus out of position and interfere with the quality of the heart images, so we ask you not to arrive with an uncomfortably full bladder for this scan.

You are welcome to eat and drink normally beforehand and to empty your bladder before the appointment if you need to. In many cases we also use a transvaginal (internal) scan to obtain the clearest views of your baby’s heart, and this is more comfortable with an empty bladder. If you are unsure how to prepare, our team will happily talk you through it.

Usually immediately after the scan. We provide both hard copy and electronic record (PDF) formats.

However, if will find something unusual, the report can be delayed for few hours when we review again the images and video clips of your baby’s heart and will write complete report.

No, we provide diagnostic scanning rather than cardiac counselling. Detailed counselling about a severe or critical heart defect — what it means, treatment options and outlook — is carried out by a fetal or paediatric cardiologist, who is the appropriate specialist for these in-depth discussions.

If our Early Fetal Echocardiography identifies a heart anomaly, we will explain what we have found and assist you with an onward referral to a fetal cardiologist and, where relevant, a fetal medicine unit. Our role is to give you a clear, early diagnosis so that the right specialist care can be arranged promptly.

Yes, we can usually check your baby’s heart earlier than a routine fetal echo appointment. If you have already had CVS and are waiting several weeks for a scheduled heart scan, our Early Fetal Echocardiography can examine the heart in detail from around 12 weeks, which many parents find far less anxious than a long wait.

This early scan does not replace the specialist follow-up you already have arranged, but it can offer earlier reassurance or, if needed, prompt earlier onward referral. Please book as soon as possible and bring your CVS results with you, so we can tailor the examination to your situation.

Yes. For very early fetal heart examination we use newest technology called “Slowflow HD’. In exceptional circumstances (like this) we can do fetal heat examination at 10-11 weeks. One of those situations is positive NIPT for Down’s syndrome (T21) when you may wish to know if the baby can have also heart defect.

We would strongly recommend to repeat the Early Echo at 16 weeks due to understandable limitations of very early Echo.

Heart anomalies vary widely in severity. Many are minor and cause few or no problems, while others are described as critical and need surgery or other procedures in the first year of life. At the most serious end of the spectrum, some defects are sadly life-limiting, whereas many others can be fully or partially corrected with heart surgery.

Because the outlook depends so heavily on the specific condition, an early, accurate diagnosis matters. Our Early Fetal Echocardiography aims to identify severe heart defects as early as possible so that specialist care can be planned in good time. Detailed discussion of a particular diagnosis and its outlook is provided by a fetal or paediatric cardiologist, and we will help arrange that referral.

In most cases, yes. To examine a baby’s heart in detail this early in pregnancy, we usually recommend both an abdominal scan and a transvaginal (internal) scan. At 12–13 weeks the heart is only about the size of a grain of corn, and the internal approach often gives the clearest, closest images.

You can choose to have the abdominal scan only, but please be aware that without the transvaginal scan the information about your baby’s heart may be incomplete or less accurate. A transvaginal scan is safe in pregnancy and is carried out gently. If you have any concerns, our team will explain the process and answer your questions before we begin.

Fetal heart beat is normally very fast. Baby’s heart starts beating at around 6 weeks, when the embryo is just 2-5 mm in length; at that time baby’s pulse is 85-130 beats per minute (bpm). The spike of fetal heart rate occurs at 9-10 weeks, when baby’s heart contracts as fast as 150-190 bpm.

There is gradual decrease in fetal heart rate between 10 and 14 weeks. Normally at 11-13 weeks fetal heart rate ranges from 145 to 175 bpm.

It was found that babies with chromosomal anomalies or heart defects can have abnormal heart beats. For instance fetuses with trisomy 18 (Edwards syndrome) and triploidy have relatively slow pulse. Contrary to that the heartbeat of trisomy 13 (Patau’s syndrome) and Turner’s syndrome fetuses is relatively fast. Very slow fetal heart beat at 11-13 weeks (below 100 bpm) is strongly associated with serious cardiac anomalies.

Significant abnormalities of the fetal heart rate at 9-13 weeks: too fast, too slow or irregular are indications for Early Fetal Echocardiography.

Ductus venosus (DV) is an important vessel which allows oxygenated blood in the umbilical vein to bypass the liver and to provide oxygen to the fetal brain.

Yes, we check DV at the time of Early Fetal Echo.

Early Fetal Echocardiography cannot diagnose isolated ventricular septal defects (VSDs) — the small “hole in the heart” that is often only visible later in pregnancy or after birth. Larger structural defects affecting the chambers, valves and great vessels can be seen at this stage, and a normal early echo is reassuring for those. A follow-up anomaly scan or a later fetal echo remains the way to look for isolated VSDs.