Fetal cardiology

Fetal cardiology is the study of the unborn child’s heart.

What we do

The fetal cardiology unit at Evelina London Children’s Hospital has an international reputation for diagnosing and managing heart problems in babies before birth.

Heart defects can be detected by a detailed ultrasound scan of a baby’s heart during pregnancy (a ‘fetal echocardiogram’). Approximately 2,000 high risk pregnancies are evaluated in our unit each year.

In most cases, we can reassure parents that their unborn baby’s heart is normal. When parents have been worrying – perhaps because they have another child who was born with a heart problem – this will be very welcome news. In some cases a problem will be detected.

We diagnose over 500 heart abnormalities in babies before birth each year. As well as detecting problems with the way the heart has formed, we can detect abnormal heart rhythms and problems with the heart function.

When serious heart defects are detected, our team of experts are in the best position to provide detailed information, discuss options, make plans for the rest of pregnancy, plan for delivery, and provide support for the family. We have a team of specialist nurses and doctors who provide support for families during their journey with us.

Read our leaflet about our fetal and neonatal imaging programme .

Our facilities

We're part of the heart department. Our facilities include:

fetal cardiac, brain and body magnetic resonance imaging (MRI)
heart surgery
heart catheterisation
detailed echocardiographic assessment including 3D echocardiography
intensive care (PICU)
neonatal intensive care (NICU).

We are the only unit in the UK to offer a clinical fetal cardiac MRI service; this may be suggested for particular forms of heart disease for which additional information may be improve the care of the baby.

We work across Evelina London Children's Hospital and Royal Brompton Hospital. You may be cared for at either or both of these hospitals depending on your needs. We'll carefully plan your care and discuss this with you.

We work with the maternity services at St Thomas’ Hospital to manage expectant patients whose unborn baby has a major form of heart disease. Our team also provide regular fetal cardiology clinics at King’s College Hospital and Medway Maritime Hospital.

If your baby is diagnosed with a very critical form of heart disease, we might recommend delivery at St Thomas’ which is the adult hospital situated next to the Evelina London Children’s hospital. This video discusses how babies which require an operation after birth might be managed when delivered at St Thomas’ Hospital.

Research supported by our team

We are actively involved in local, national and international research to develop the care for unborn babies with major forms of heart disease.

Approved projects that we run together with King’s College London include:

iFIND: intelligent Fetal Imaging and Diagnosis – finding new technologies that allow scanning to be carried out with multiple ultrasound probes and improved fetal ultrasound imaging through automated image processing.
Development of fetal heart MRI – recruiting pregnant women carrying a fetus with congenital heart defect for fetal MRI.
PROMETHEUS – a randomised prospective trial of machine learning to assist in routine fetal anomaly ultrasound scans. It includes both fetuses with normal hearts and those with congenital heart disease.
FIMOX (fetal imaging maternal hyperoxia) – assessment of fetal response on ultrasound ± MRI to short period of maternal hyperoxygenation (oxygen delivered by a facial mask to the pregnant women).
BEATS Study – recruiting participants were the baby has a suspected arrhythmia or is at risk of arrhythmia to assess the fetal heart rhythm using fetal ECG.
Placental-Cardiac Imaging Study (PLACARD) – This project aims to understand the relationship between placental function, prenatal heart development and early cardiovascular health, using a unique combination of novel 3D/4D fetal MRI methods to generate a comprehensive, non-invasive profile of the fetoplacental circulation. Following prenatal imaging, participants will be offered postnatal follow-up for their babies at one year of age, in order to provide longitudinal insights into the relationship between intrauterine environment and early markers of cardiovascular health.

We are working with national and international units running studies which collate anonymised data when parents have specifically consented to data-sharing, on some specific heart lesions, for example, aortic stenosis, pulmonary stenosis, Ebstein’s anomaly/tricuspid valve dysplasia, cardiomyopathy. All studies require parental consent to be provided and if you are interested please mention this to the fetal cardiology team.

Hello, my name's Claire and I'm a Fetal Cardiology Nurse Specialist at Guy's and St Thomas' NHS Foundation Trust.

This film will help prepare you for what to expect when your baby needs expert cardiac care shortly after birth.

We will explain how we're going to look after you, and how we're going to look after your baby.

You'll have already met some of our team members, but there's lots more of us all working together to provide the best possible care for you and your baby.

We'll arrange for you to give birth on our on-site maternity unit.

The expert fetal medical team and midwives will be there to support you throughout.

When your baby is born you'll be able to have a cuddle and take some pictures.

We'll then need to transfer them to the Neonatal Intensive Care Unit (NICU), or the Pediatric Intensive Care Unit (PICU) and will do a full top-to-toe assessment of baby.

In the most severe cases, your baby might need to be transferred straight away. They are in good hands, and our team are very experienced in looking after babies with cardiac conditions.

There will be other families on the unit experiencing the same treatment as you.

I'm Marie Grimley.

I'm mother of Hattie Grimley who had a repair of the coarctation at day 10 of life.

When we found out at our 20-week scan that there was an abnormality with the heart, my husband and I sat in the car, and cried our eyes out.

The day of surgery was the most difficult day of our lives.

We had to watch Hattie being wheeled away into the theatre, and not knowing how it was going to go, or how long she was going to be in there for.

We distracted ourselves as much as possible by going out for a walk, getting some fresh air, until we got the call.

When we got the phone call from Mr Salih to say that the operation had gone well, my husband picked up the phone.

He immediately started crying, and nearly dropped to the floor because we had been so anxious the whole time.

When we saw Hattie for the first time after she'd come out of surgery, it took our breath away and there was definitely a few tears.

But once the nurse reassured us and the doctors reassured us that everything had gone smoothly, and they went through all of the lines, all of the machines, all the medicines that she was on it put us a lot more at ease that we were able to then sit at the bedside, and feel a little bit more calm about the whole situation.

My name is Alice Hurn, and I'm a Fetal Cardiology Nurse Specialist at Guy's and St Thomas' NHS Trust.

Babies have lots of wires and tubes to help us monitor them, and supply them with medicine.

Some of these tubes supply life-supporting medicine that your baby will need before their surgery is complete.

They will have lots of scans and tests to help us understand how they're coping, and to take the steps to precisely plan your baby's surgery.

A lot of changes happen in your baby's circulation after they're born, and so we need to give them some time to adjust.

The surgery will usually happen within the first two weeks, giving you lots of time for cuddles and to get to know your baby.

We always try to provide you accommodation so you can stay near your baby, and you can visit them on the unit at any time of the day.

Although you may not be able to feed your baby before their surgery, our team will be making sure that they have all the fluid and nutrients that they need.

Before surgery, you will meet the team who will look after your baby during the operation, and they will talk you through the surgical plan and process.

We take a lot of time to prepare baby before the operation even starts, and so it's going to feel like a long day for you.

But the team will be there to support you, and keep you updated throughout.

After surgery your baby will be supported on the Pediatric Intensive Care Unit, where you'll be able to see them.

PICU can be a busy and noisy environment.

There will be tubes and wires on your baby to help us monitor them.

We're looking at their heart rate, their rhythm, their blood pressure, and their oxygen levels and many other things.

They also give medications to keep your baby comfortable, free from pain, support their heart, and help them to wee.

Initially, your baby will need specialist one-to-one nursing care, and they'll be making small adjustments to make sure that your baby stays comfortable and stable.

After surgery, your baby will hold on to fluid in a different way so they will look puffy, this is normal.

Our team are highly trained and always have a plan in place for any changes in your baby's condition.

We will always talk to you about this, and you can ask questions at any time.

During your baby's treatment, it's really important that you're looking after yourselves, so you're eating and drinking and getting as much rest as possible.

As your baby starts to recover, we'll remove some of the tubes and wires, start to reduce the medications and let them wake up a little bit more.

You'll be able to have cuddles, help with their cares, and start doing things like nappy changes.

We can't say how long your baby will take to recover, as every baby recovers differently.

We'll give you a diary that will explain what's happening each day, it will help any siblings to understand as they will be worried too.

You can also show it to your baby when they are older.

After surgery a lot of babies cannot feed, if your plan is to breastfeed, we can help you to express your milk and keep it safe until your baby is ready.

When the time is right, we'll help you to gradually introduce feeds.

When your baby's ready, they'll be transferred to the cardiac ward, and they'll no longer need one-to-one nursing care.

This is a huge step in your baby's road to recovery, and a time for you to get to know your baby and spend more time feeding and handling them ready for home.

In order for your baby to be discharged home, we need to make sure that they're well, that they're feeding and weeing - and that they're able to gain weight.

It's also a time to make sure that you feel confident in caring for your baby at home.

It's not unusual for your baby to be discharged on some medicine.

They will have an outpatient appointment to check their progress.

We're here to give you all the reassurance you need before you go home with your baby, and we will give you the contact details of who you can call for advice and support when you're home.

When we went home, we were fully supported again through the medications - making sure that we were happy with going through absolutely everything - and we've just celebrated her third birthday, where she's been bouncing around on a bouncy castle running around and enjoying life with all her friends and family.