Fetal echocardiograms: Finding more heart defects before birth

In 2011, Norton Children’s Heart Institute identified an area where we could improve the care provided to families in our region. We have been working hard to make things better ever since. We reviewed the records of all babies who had heart surgery at Norton Children’s Hospital. We found that only about one-third of the families had known about the heart condition during pregnancy. This included a number of babies who had very serious, complex heart defects that possibly could have been found on prenatal ultrasound. Since then, we have been diligent in trying to improve the chances that babies with complex heart disorders in our region are identified during pregnancy.

Research studies show that when a heart issue is discovered during pregnancy, the babies do better after birth. We also know that families are much better prepared if they know about their baby’s heart condition during pregnancy, and that suddenly finding out after birth is very stressful on a family. In addition, babies born at a regional hospital often need to be transferred to Louisville, which can mean that mother and baby are separated until mom is discharged from the hospital after giving birth. Our team at Norton Children’s Heart Institute has been working to improve prenatal diagnosis of heart defects in three specific ways:

• Education and training. We have been working with obstetric providers and sonographers to help provide education and training to improve ultrasound screenings so that more heart defects can be identified sooner. This can help to raise suspicion about a possible heart issue so that further testing can be performed. We have provided training to sonographers and obstetricians in their offices and have welcomed sonographers to spend time with us in the echocardiography lab at Norton Children’s Hospital to learn more about imaging of heart defects during pregnancy.
• Comprehensive testing in Louisville. We have been working to improve access to comprehensive fetal echocardiograms done by pediatric cardiologists in the Louisville area. We have state-of-the-art equipment and have increased the number of appointments available at Norton Children’s Heart Institute downtown. We also offer fetal echocardiograms at Norton Women’s & Children’s Hospital in St. Matthews. The number of patients seen at these locations has increased steadily over the past several years as we have been able to see more and more expectant moms for testing.
• Outreach across the region. We have improved access to fetal echocardiograms for families throughout Kentucky. We know it can be difficult for families to travel to Louisville to have testing performed, so we have been working with providers in various Kentucky communities to offer fetal echocardiograms locally. We currently are able to perform fetal echocardiograms at King’s Daughters Medical Center in Ashland, Kentucky; Norton Children’s Maternal-Fetal Medicine in Paducah, Kentucky; Owensboro Health Regional Hospital in Owensboro, Kentucky; and Saint Joseph East in Lexington, Kentucky.

We have been offering these services for seven years, and hundreds of these studies have been performed. We have found that we are able to accurately and efficiently identify patients with complex heart conditions during pregnancy, and then refer them for further testing. We have developed partnerships with local providers and trained obstetric sonographers in these outreach locations to perform the full set of images for a fetal echocardiogram. We have established secure telemedicine links with these locations so images can be sent from the local testing centers to Norton Children’s Hospital, where the images can be interpreted by our specialty pediatric cardiologists from the University of Louisville. This process establishes that the family plans to deliver the baby at a center where a team of newborn providers can be available immediately after birth to ensure the best possible outcome.

Brian Holland, M.D.