Fetal care and treatment

Dr. Bhawna Arya

Dear Colleagues:

I wanted to share with you the hot-off-the-presses updated guidelines entitled “Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography” published in the Journal of the American Society of Echocardiography last month. The co-authors are experts in the field, and our own fetal cardiologist Dr. Nelangi Pinto is one of the co-authors.

This new document replaces the 2004 guidelines and is focused on referral indications for fetal echocardiogram and has been updated from the previous American Heart Association (AHA) guidelines from 2014.

There are several important changes to share and a summary created by our Seattle Children’s Fetal Cardiology team is included here, along with the original guidelines paper. The highlights are that a fetal echocardiogram is no longer indicated (based on low risk <3%) if the cardiac views are visualized and normal on obstetric anatomy scan and the following are present in isolation:

1. In vitro fertilization
2. Nuchal translucency (NT) less than 3.0 (between 3.0 and 3.5 MAY consider fetal echo)
3. Maternal lithium or anticonvulsant exposure
4. Obesity (BMI >30)
5. Single umbilical artery (two-vessel cord)

Of course, if any concerns are raised by your team or the patient for any reason from a fetal cardiac perspective, the Seattle Children’s Fetal Cardiology team throughout the WAMI region (Washington, Alaska, Montana Idaho) is always more than happy to perform a fetal echo and consult with the patient. Our goal is to provide the best fetal cardiology diagnosis, care and counseling to families and make sure that as providers, your team has all of your questions regarding the fetal heart answered, no matter what the indication.

I am attaching the new guidelines paper (Table 1 includes all of the indications for fetal echo) as well as our Seattle Children’s concise summary of indications. Please reach out with any questions or concerns.

Bhawna Arya, MD

Associate Professor | Department of Pediatrics

Director | Prenatal Diagnosis Program

Director | Fetal Cardiology

Director | Advanced Imaging Fellowship | Division of Pediatric Cardiology

University of Washington School of Medicine

Seattle Children’s Hospital, Heart Center and Fetal Care and Treatment Center

206-987-3934  OFFICE

206-987-3839  FAX

[email protected]

Fetal Care and Treatment Center

Phone: 206-987-5629

Email: [email protected]

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Maternal-fetal surgeons Drs. Bettina Paek and Martin Walker review a patient’s scan.

Last year, Seattle Children’s brought on board renowned fetal intervention specialists Drs. Bettina Paek and Martin Walker to lead Seattle Children’s and UW Medicine’s new Maternal Fetal Intervention and Surgery program alongside Dr. Rebecca Stark. As members of the Fetal Care and Treatment Center at Seattle Children’s, they are part of a multi-disciplinary team that offers fetal diagnosis and treatment and helps parents understand what to expect after their child is born. The team includes more than four dozen specialists in maternal-fetal medicine, neonatology, cardiology, urology, nephrology, neurology, otolaryngology, craniofacial, surgery, genetics, and radiology.

Over the last year, the Center performed 2,449 fetal echocardiograms across the WAMI region, more than any other provider group in the Pacific NW, with more than 99% accuracy of prenatal diagnosis of major heart conditions. Drs. Paek and Walker performed 34 laser ablation procedures for twin-to-twin transfusion syndrome (TTTS) at the University of Washington Medical Center Montlake Campus (UWMC), with dual survival for more than 90% of the procedures (compared to a national average of 60%).

Pediatric cardiologist Dr. Bhawna Arya, director of Fetal Diagnosis, reviews a scan with a patient.

Our Congenital Diaphragmatic Hernia Program (CDH) team, led by Dr. Rebecca Stark, diagnosed 16 babies with CDH who required newborn surgery and achieved over a 90% average survival rate, again significantly higher than the national average.

We spoke with Drs. Walker and Dr. Paek, as well as with Dr. Bhawna Arya, who leads Seattle Children’s fetal diagnosis program with Dr. Edith Cheng and fetal cardiology, to hear about what is coming in 2023 and answer questions commonly asked by community providers.

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