Fetal Echocardiogram

[MarineWife]

I was told I couldn't reschedule my Level II ultrasound until about 21 weeks because I am scheduled to have a fetal echocardiogram as well. I had Level II u/ses with my last two and no one ever mentioned an echocardiogram. Is this routine or something extra? The MFM doc I'm seeing (only for ultrasounds, otherwise I see my homebirth MW) has offered/recommended all kinds of extra testing and monitoring that I have declined. He has suggested it because I am AMA (I'm 40, will be 41 when this baby is born), have PCOS so am supposedly at an increased risk of developing GD and have RPL issues. The only thing I want is the Level II u/s. I don't understand why I would need a fetal echocardiogram as well.

I was told that if I didn't have the echo I could have the Level II u/s any time after 14 weeks. I'm 15 weeks now. My dh is deploying for a year at the end of this month. I'll be about 17 1/2 weeks then. Not only would I like to have the u/s before he leaves so he can get any news, good or bad, right away but also because I know I'll have childcare for my other young children. I don't have reliable childcare otherwise so may not even be able to make an appointment for an ultrasound after he's gone. I cannot take my kids to this doc's office. There's not enough room in his ultrasound room.

Does anyone have any reason why a fetal echocardiogram would be necessary without indication of any problems or reasons not to have it done unless there is a specific medical reason why I would need it?

[jaronsmom]

 I had a fetal echo because of a family history of cardiac defects.  Is there any indication for the test that you might not be aware of?  All my blood screening tests were negative and the quad screen was negative so my fetal echo was ordered strictly because of my family history... perhaps your midwife can discuss these things with you.  I also saw MFM for US only and they tried to order a boat load of tests that I did not want and were not ordered by my providers. 

If you don't want a test, refuse it.  If there's a reason it's ordered and you still don't want it, you can refuse.  For me, the echo was negative and this gave me the courage to radically change my birth plan and switch from a high risk OB practice to a midwifery group.  Good luck with everything!

[windymama]

Hmm.  If there's no family history then it could be the MFM dr is trying to cover all of his/her bases.  It seems unnecessary though if you don't have a family history and you're not far enough in your pregnancy for the other screenings to flag anything and you're having a Level II anyway.  Our pedi cardis have always done/recommended fetal echos at around 20 weeks as the baby's bigger but they can still see the heart.

If it's a really significant heart defect it will show in the Level II (our DD's defect actually showed in a routine 20 week scan) and you can get an echo afterwords.  If it's a lesser defect it may not show on the Level II or fetal echo.  With this baby we've already had the fetal echo and will be having a formal echo a month postpartum to make sure they didn't miss anything.

[Soul-O]

Hi MW:

I'm so happy to hear that your pregnancy is going well.

I had two fetal echos about 4 weeks & 8 weeks after the level II u/s with my latest baby because of my age (36 at the time of conception and delivery) and DH's family history of heart defects.  The MFM doc told me that women over 35 are more likely to birth babies with heart defects, so the fetal echo is essentially standard procedure for AMA moms.  My little guy did have a small hole in his heart (ventral septal defect - VSD) that was discovered on the level II and explored more closely on the two fetal echos.  The second one showed that the hole had resolved, and a follow up echo done when Jonah was 6 weeks old confirmed it.  I was happy to have the reassurance that all was well with Jonah's heart, so I didn't mind having the echos.  I think Tricare covers all of it anyhow.

Congrats!  Here's to a happy, healthy rest of your pregnancy and a wonderful birthing experience.

[noahs.mom06]

If you don't want the echo, I would decline it... FWIW we had a fetal echo that did NOT detect our daughter's VSD, they didn't know about it until after she was born. It didn't end up being an issue anyway, it closed up on its own (and she had other issues that were far more important at the time so they didn't pay that much attention to it)...

[Charlize]

Fetal echo is not a necessity unless there's reason to have it, such as family history or if they some something in the ultrasound that would be worrisome and may be linked to heart defects. DD3 had an SUA and we had a fetal echo done later in the pregnancy due to that.

[HappyMonkey]

Isn't there always a hole between the chambers of the heart before a certain fetal age?

[windymama]

Quote:

Originally Posted by HappyMonkey 

Isn't there always a hole between the chambers of the heart before a certain fetal age?

That's the ductus arteriosus and it usually closes after birth.  It has nothing to do with VSDs but can also cause problems if it doesn't close after birth.

[MarineWife]

Wow, sorry to everyone for not answering this. I didn't get any email notifications of responses so thought no one had posted. Turns out I didn't subscribe to my own thread. I'm still trying to figure out how the subscriptions work with the new website.

Anyway, I googled it and read that it's not routine, even for women who are considered AMA. It's usually only done if there is a specific indication like family history of heart defects or Type I diabetes and a few other things, none of which apply to me. I haven't talked to my MW about it yet but I am going to decline it. Like some of you have said, a Level II u/s should pick up any possible defects and I can have further u/ses from there if needed. Also, my MW should be able to pick up an irregular heart beat during my prenatals.

My dh deploys for a year in about a month. If I decline the fetal echo, I can have the u/s earlier. It really annoys me that the doc told me to schedule the u/s so late so that he could do a procedure that he did not mention to me and give me a choice to accept or decline.

[kalamos23]

We *do* have a history of fetal heart defects and had a level 2 u/s with DD and with this one. They only go to the echo if they see something worth noting or can't see the heart well enough on the level 2. So I think you should be perfectly fine declining it.

[MarineWife]

Originally Posted by kalamos23 

They only go to the echo if they see something worth noting or can't see the heart well enough on the level 2. So I think you should be perfectly fine declining it.

Yeah, that's the impression I got from what I read. I don't know why this doc wants to do that other than to get more money from my insurance company. He knows I'd decline it because I've declined all the other testing he does other than the NT scan and the Level II u/s.

[mambera]

OP:  I think drs order the fetal echos a lot because they see it as a really low-risk test and if it does happen to pick up a serious defect it can make a huge difference to the baby's health and survival.  I think they see it as kind of a can't-lose.

I had one with my DD because they found another irregularity on the 20-week US.  In fact there was *no statistical association* between the irregularity they found and any cardiac defects, but the Ob wanted to get the echo because, in his words, "If there's something wrong then there might be something else wrong."  :rolleyes

By the same reasoning he wanted me to get an amnio, again even though I was at no higher risk for chromosomal abnormalities than anyone else in my age group. 

I declined the amnio but took the echo, mostly because I did feel the echo was pretty low-risk and didn't see a strong reason to decline it.  It was normal, as one might have expected.

But if you do have any reason to decline it (like the scheduling/baby care issues you mentioned) I'd let your dr know that and see if he can give you any convincing reason why you should have the echo.  If he can't, I'd skip it and feel fine about it.

Originally Posted by HappyMonkey 

Isn't there always a hole between the chambers of the heart before a certain fetal age?

That's the ductus arteriosus and it usually closes after birth.  It has nothing to do with VSDs but can also cause problems if it doesn't close after birth.

The ductus arteriosus is not in the heart, it's a shunt between the pulmonary artery and the aorta.

All fetuses do have a hole between the heart chambers (the foramen ovale) but it is between the atria, not the ventricles. 

(The fetal circulation is sort of reversed from the postnatal, because oxygenated blood comes from the placenta rather than the lungs.  This requires the presence of three shunts - the foramen ovale, the ductus arteriosus, and the ductus venosus, all of which close in the hours after birth.)

It is pretty common for the foramen ovale to fail to close completely after birth; this usually results in a small atrial septal defect which often doesn't pose a problem (although it may).  A hole between the ventricles is never normal and a large one can be deadly if not repaired early.

[windymama]

Originally Posted by mambera 

The ductus arteriosus is not in the heart, it's a shunt between the pulmonary artery and the aorta.

All fetuses do have a hole between the heart chambers (the foramen ovale) but it is between the atria, not the ventricles. 

(The fetal circulation is sort of reversed from the postnatal, because oxygenated blood comes from the placenta rather than the lungs.  This requires the presence of three shunts - the foramen ovale, the ductus arteriosus, and the ductus venosus, all of which close in the hours after birth.)

It is pretty common for the foramen ovale to fail to close completely after birth; this usually results in a small atrial septal defect which often doesn't pose a problem (although it may).  A hole between the ventricles is never normal and a large one can be deadly if not repaired early.

Oops.  Thanks for pointing out my error.

[deblender]

I'm appalled at your ignorance and assumptions in regard to your physicians.  Do you really think doctors go to school for 12+ years, work horrendous hours, leave their own families at all hours of the day and night to wait on you hand and foot, and then for some reason try to give you inappropriate advice?  The doctors referred to in this thread were recommending exactly what is appropriate for you.  First, Marinewife, level 2 ultrasounds are supposed to be done at 20 weeks.  If they are done earlier (even as late as 18 weeks) the fetus has not developed fully, and not all defects will be detectable. The MFM was not trying to screw you over by advising your level 2 at 20+ weeks.  That would actually be preferable for detection.  Second, OB's and MFM's do not get any money from ordering an echo for you.  A pediatric cardiologist is required to do the echo, so your OB/MFM will not get one red cent for advising you get an echo.  Third, in regards to "Mambera" quoting her physician with rolled eyes for ordering an echo after finding another unrelated defect on level 2: your OB is exactly right.  Any abnormality found on level 2 dramatically increases the risk of a concomitant heart defect.  This is a clear cut indication for echo, and if your Ob hadn't ordered the echo they would not be adhering to the standard of care, and you would have turned around and sued him for not ordering the echo if a defect had been missed.  I don't understand the animosity in this country toward doctors.  They're just trying to do their best to help you, and you bad mouth them as if they are out to hurt you and take all your money.  I've never met a doctor who didn't care about patients, or who got paid commensurately with the time and energy they spend.  If they were trying to maximize their hourly pay, they would be in business or investment banking, not medicine. 

[polishprinsezz]

sniff sniff! i smells me a person who works in the medical field with the belief that having this degree automatically makes them superior. is it not odd that their very first post is inflammatory to your so called ignorance. even if the procedure is low risk why does a pregnant women with no complications need to subject themselves to it? many of these so called low risk procedures are inconvenient and a waste of time. i believe deblender is a doctor or nurse trolling our forum looking for ammo for whatever purpose that they feel is needed.
 

Originally Posted by deblender 

I'm appalled at your ignorance and assumptions in regard to your physicians.  Do you really think doctors go to school for 12+ years, work horrendous hours, leave their own families at all hours of the day and night to wait on you hand and foot, and then for some reason try to give you inappropriate advice?  The doctors referred to in this thread were recommending exactly what is appropriate for you.  First, Marinewife, level 2 ultrasounds are supposed to be done at 20 weeks.  If they are done earlier (even as late as 18 weeks) the fetus has not developed fully, and not all defects will be detectable. The MFM was not trying to screw you over by advising your level 2 at 20+ weeks.  That would actually be preferable for detection.  Second, OB's and MFM's do not get any money from ordering an echo for you.  A pediatric cardiologist is required to do the echo, so your OB/MFM will not get one red cent for advising you get an echo.  Third, in regards to "Mambera" quoting her physician with rolled eyes for ordering an echo after finding another unrelated defect on level 2: your OB is exactly right.  Any abnormality found on level 2 dramatically increases the risk of a concomitant heart defect.  This is a clear cut indication for echo, and if your Ob hadn't ordered the echo they would not be adhering to the standard of care, and you would have turned around and sued him for not ordering the echo if a defect had been missed.  I don't understand the animosity in this country toward doctors.  They're just trying to do their best to help you, and you bad mouth them as if they are out to hurt you and take all your money.  I've never met a doctor who didn't care about patients, or who got paid commensurately with the time and energy they spend.  If they were trying to maximize their hourly pay, they would be in business or investment banking, not medicine. 

[Goddess3_2005]

Wow what a doosie for your first post. I smell troll.

Doctors are not always right infact hundreds of thousands of people die each year due to medical mistakes. Being a doctor dose not make one God. Its sad that most alopathic doctors think they are. They are not taught patient care they are taught test and prescribe or cut. Thats all they do. They do not know how to heal the whole person. Doctors often run tests that are unneeded just becasue its the "standard of care" i hvae had more than one doctor run a test  and told me they didn't think that I needed the test, but they would run it anyways because thats the standard of care. 

Not saying that the test would not be useful in finding out about a birth defect, but I think doctors tend to over test because thats all they know how to do.
 

Originally Posted by deblender 

I'm appalled at your ignorance and assumptions in regard to your physicians.  Do you really think doctors go to school for 12+ years, work horrendous hours, leave their own families at all hours of the day and night to wait on you hand and foot, and then for some reason try to give you inappropriate advice?  The doctors referred to in this thread were recommending exactly what is appropriate for you.  First, Marinewife, level 2 ultrasounds are supposed to be done at 20 weeks.  If they are done earlier (even as late as 18 weeks) the fetus has not developed fully, and not all defects will be detectable. The MFM was not trying to screw you over by advising your level 2 at 20+ weeks.  That would actually be preferable for detection.  Second, OB's and MFM's do not get any money from ordering an echo for you.  A pediatric cardiologist is required to do the echo, so your OB/MFM will not get one red cent for advising you get an echo.  Third, in regards to "Mambera" quoting her physician with rolled eyes for ordering an echo after finding another unrelated defect on level 2: your OB is exactly right.  Any abnormality found on level 2 dramatically increases the risk of a concomitant heart defect.  This is a clear cut indication for echo, and if your Ob hadn't ordered the echo they would not be adhering to the standard of care, and you would have turned around and sued him for not ordering the echo if a defect had been missed.  I don't understand the animosity in this country toward doctors.  They're just trying to do their best to help you, and you bad mouth them as if they are out to hurt you and take all your money.  I've never met a doctor who didn't care about patients, or who got paid commensurately with the time and energy they spend.  If they were trying to maximize their hourly pay, they would be in business or investment banking, not medicine.