Fetal Cardiac Clinic

This clinic is part of the Fetal Cardiac Program, which is integrated into the Division of Cardiology and the Labatt Family Heart Centre at SickKids. As the only place where newborn heart surgery is performed in the province, all high-risk pregnancies carry babies with heart disease come through our doors. This afford access to high quality, expert-level fetal cardiac care for all Ontarians.

The Fetal Cardiac Program is made up of a multidisciplinary team that provides detailed evaluation, counseling and treatment for heart problems in the developing baby during pregnancy. We work closely with family doctors, midwives, community and high-risk obstetricians throughout Ontario, as well as geneticists and other pediatric subspecialists. We partner with high-risk obstetrical providers to provide a range of fetal therapeutic options, if applicable, and to refine delivery planning. The Fetal Cardiac Program is a teaching program in affiliation with the University of Toronto.

Heart problems in the developing baby may result from a variety of factors, such as

• abnormal development of the heart (congenital heart disease)
• heart rhythm disturbances
• problems with the heart muscle (cardiomyopathy)
• conditions outside the heart
• complications from twin pregnancy
• health problems in the mother, such as diabetes or exposure to certain medications

When is a fetal echocardiogram performed?

As soon as a cardiac abnormality is suspected by your pregnancy provider, we would recommend a fetal echocardiogram and consultation, regardless of the timing in the pregnancy.

If a cardiac abnormality is not suspected, there may still be reasons to perform a screening fetal echocardiogram. These reasons may include, but are not limited to, conditions identified outside the baby's heart. includign a suspected or known genetic condition; twin pregnancy; or certain health problems or medications in the mother that may affect the baby, such as diabetes.  In addition, expectant parents with heart disease themselves or who had a prior child with heart disease are eligible for a screening fetal echocardiogram.

Routine screening fetal echocardiograms are performed in the mid-second trimester (18-20 weeks) to optimally visualize the heart. We also offer screening fetal echocardiograms as early as the first trimester (12-14 weeks) for certain indications, i.e., family history. It is our practice to book a follow-up evaluation at 18-20 weeks for those undergoing this type of early fetal echocardiography. 

• No lotions, creams or oils on your abdomen for 3 days before the appointment
• Eat and drink normally before the test
• Bring a list of your current medications
• Bring your health card
• The appointment will include a fetal ecuo and consultation with a cardiologist (expect 2-3 hours for one baby or 3-4 hours for twins)
• Fill out the prenatal questionnaire on MyChart. Instructions will be emailed to you after your appointment is booked.

What happens during a visit?

After you register for your test, you will be asked a series of routine questions about your pregnancy and general health. This helps us ensure we are providing a complete evaluation of your baby’s heart.

A fetal echocardiogram, which is a type of ultrasound, is performed on your abdomen by a member of our team, either a sonographer or fellow who has been specifically trained to perform this evaluation. The test itself may take anywhere from 30 to 60 minutes and depends on how easily we are able to obtain clear images of the heart. Because we are examining the baby within the womb, the image quality is very dependent upon the position and activity of the baby. To improve the images, during this test you may be asked to empty your bladder, move from side-to-side or even take a brief walk. You may eat or drink before this test, and it is not necessary to have a full bladder. For these reasons, a longer test does not imply that there is a heart problem.

During the test, the sonographer or fellow will not give you the results. After your test is complete, the person performing your scan will review the images with one of the physician members of our team. The physician, who is a specially trained fetal cardiologist, may choose to obtain more images at this time. Again, this does not necessarily mean anything is wrong with your baby's heart.

After all of the images are obtained, the doctor will review the results of the test with you. If you have signed up with MyChart, you will be able to view your results directly; if not, you will be given or emailed a copy of the results, if you'd like. A nurse is available to assist you in understanding your child’s condition and to plan your next steps. 

As this may be a stressful time for you, we would recommend that your partner or another family member accompany you to this appointment. We would recommend against bringing small children to this appointment. Please review our latest visitor guidelines prior to your appointment. The Women's Auxiliary Volunteers (WAV) Play Park offers daycare services for children over 2.5 years of age, which are free of charge. 

What if there is a heart problem?

After the fetal echocardiogram, a doctor will speak with you and explain the results.

At times, it may be difficult to obtain a clear image. Although there may not be any abnormalities detected, the imaging may not be as complete as possible. In these cases, we may book a follow-up test to re-assess the heart; this does not mean that there is a heart problem.

If an abnormality is detected, a doctor and nurse will speak with you privately. During this time, we will provide you with as much detailed information about the heart problem as can be determined from the images. The effects of the heart problem on the pregnancy, delivery and throughout the child’s life will be discussed. There may be a need for open heart surgery. We will draw diagrams that you may take home with you. It may be necessary to perform further imaging with fetal MRI at SickKids. We will discuss all options available for management of your pregnancy. Based on the plan we develop with you, it may be necessary to refer you to a specialized obstetric program to ensure the best delivery plan is in place.

Normally, we will book additional appointments during the pregnancy to re-assess your baby's heart and to prepare you and your baby for delivery. Referral to other members of the team (social worker, lactation consultant, resource navigator, etc.) will be arranged to assist you in coping with and preparing for your journey.

Are there prenatal treatment options?

Sometimes there are treatment options that can be offered to the developing baby. Some are in the form of medications that can pass through the womb to the baby. Others may involve minimally invasive catheter-based interventions. The Fetal Cardiac Program at SickKids is the only program in Canada that offers these types of fetal procedures. Many of these treatments help the baby, but they are typically not curative. This means that even though fetal therapy may be successful, follow-up is still necessary at SickKids after birth. 

How do I prepare for the delivery of my baby with a heart problem?

For parents anticipating afterbirth cardiac care at SickKids, the clinical nurse coordinators will provide you with support, teaching, and logistical information to help prepare you for the admission. They will offer consultations with lactation support, social work, resource navigation, and other specialty service providers. This information will be reviewed with you in person and is available in the Fetal Cardiology Pamphlet.

Where can I look for emotional support?

Finding out that something may be wrong with your baby’s heart can be a traumatic experience. We are here to support you and provide you with resources and referrals, where necessary.  In addition, we have launched a peer support program. If you have decided to continue the pregnancy, you may be connected to a peer mentor who has had a child with a similar condition. This program is overseen by psychologists, social workers, and parent liaisons within the Labatt Family Heart Centre.