A 28-week heart [Fetal Echocardiography]

Ultrasounds are harmless and can be performed from the first consultation, but there are 3 that are the most important: First trimester screening (week 12), morphological ultrasound (week 20) and fetal echocardiography (week 28) in the latter we review that the heart has no defects and if we detect them, prepare for the moment of birth.

These studies are very subject to the interpretation of the doctor, a lot of experience and knowledge is required to detect when something is out of the ordinary, and as #KnowledgeIsSuccess Dr. Carlos Monsalve, expert in maternal fetal care at Creafam, explains to us how the test should be performed. Third trimester echocardiography.

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Hello, how are you, very good afternoon to all our Creafam subscribers and patients. Well, today I wanted to remind you of the important studies we have here at Creafam. The first, that of the first trimester, that of week 11-13 for chromosomal problems, that of week 20, very important for morphological studies to detect anatomical problems, but today in particular I want to talk to you about the third important study, which is Fetal echocardiography, we can normally do it between week 26 and 30, we take the average of week 28 today, we were allowed by a patient who is recommended by an external doctor who comes to have a fetal echocardiography. What does it consist of? It consists of studying your heart, seeing your heart to determine whether or not you have any congenital heart disease, any malformation of the heart. At this moment we are going to show you.

Maternal fetal care consultation begins

You will be able to watch it on any screen, here in front of you, on this one, wherever it is comfortable for you, you will be able to see your baby. Yes, the head is actually up here, the face is here, you’re going to see it from the side, like this in profile, right now we’re going to arrange it so that it looks better. This looks like this in profile: The forehead, the eye, the nose and the mouth, what is moving here is her heart, it comes down here and here the buttocks, right? The exit would be down here. Down here and it’s closed. And what you see here are your baby’s buttocks, one buttocks the leg over here, the other compi and the leg over here. Does it come out? This whole little mattress that will be seen here as light gray, this here is the placenta, it is well positioned, it is on the back side and it is not placenta previa, it is normal. Everything we see in the black ultrasound is water, everything that looks black is water, it is seen with a very good amount of liquid. Right now what we are going to do is listen to your baby’s heart, which is here moving, look also moving, but your baby.

We are going to put it here so that it can be heard better. It goes fast, it goes at a good pace and it has a heart rate of 151, which is normal, between 120 and 160. And we are going to start measuring to see how it is growing, look, this is the little head, the crown, seen from above. Here is the crown and here we measure the head. From one hundred to the other DBP: 70.7 Head circumference: 264 He already put a little hand here in front of his face. The forehead, the eye, the nose and the mouth and here look, his hand. These are the little fingers of this hand, which are here in front of the face and the other hand is behind here.

Here it comes from the shoulder to the elbow and from the elbow to the hand, and surely the little fingers are placed back here. They will be hidden here, as if he had them here on his shoulder, the fingers will be seen right now and this is the nape, the nape of the neck and the spine. The column is here, lower his column. The entire column, column, column, reaches here until the tailbone here looks very closed and then the legs, he throws them up. And there it is, look how it is moving and stretching. This is a small slice at the level of the stomach, this black circle is the stomach that, seeing it filled with liquid, tells us that the liquid it swallows passes without any difficulty through the neck and reaches the the stomach, throughout the pregnancy it should always be seen as full. And here we measure the abdominal circumference. Abdominal circumference 239.1, here we arrive at the buttock area.

Butt and leg over here, this little white line is the bone of the leg, the femur and this one here is the other femur and here come the legs crossed look, here the knee comes out, there one foot sticks out and this is the other foot. And indeed, mra here in the middle, El pilín! This is the bag of the testicles, even inside you will see these little gray circles, they are the testicles that are already descended and here is your penis. OK? So there is the kid, indeed, a child. and we measure the leg bone, the femur, I put a little pressure here, look, it started to move, it has already changed its position. Here we measure it from the knee to the ankle, let me have it here… When they are sitting, because sometimes it is more difficult to measure the legs, but hey, there it is. Femur 50.7

The amount of liquid, which looks very good, we measure here in a lagoon, which is the maximum lagoon, which is at 46, which is normal, it has a very good amount of liquid. There you see him in profile. I’m checking to see if one of those cooperates for a nice photo. Because here he has the face, the forehead, the nose and the mouth and his profile and the hand that he has there in front of him look very well aligned, let’s see if he removes it now and lets us see some nice image in 4D, but look, It casts a lot of shadows there, so of course not there, let’s see if it moves right now.

Echocardiogram, fetal echocardiography or heart study

Let’s start by checking the heart, okay? This is a small slice at chest level, here is his beating heart. Left is this side, right is this side, the tip of the heart towards the left side. This is the column, if I make an imaginary line starting in the middle of the heart, it makes an angle of approximately 45 degrees, it is the cardiac axis, that tells us that it has deviated us neither to the left nor to the right, it is in a normal position. The right atrium will look more rounded, the left will look more elongated and the ventricles will look the same size. Between the two atria, this little door that opens and closes is the foramen ovale, it will close but until the moment of birth. . Right now the normal thing is that it is open and these are the valves of the heart: Mitral, tricuspid, which are at the same level opening and closing at the same time and between the two ventricles you can see this little white line that is the interventricular septum that prevents the passage of blood from one side to the other.

Here I put colors, this is to see how the blood passes through the valves. There are no sudden changes in color, which tells me that these valves open and close correctly. There… There you can see how the blood passes without sudden changes and in the middle this gray frangite that you see is the interventricular septum that prevents the passage of blood from one side to the other and must always be closed. From the right ventricle, which is this one, this black stripe comes out downwards, that is the exit of the pulmonary artery, and from the left ventricle this one that goes up and crosses is the exit of the aorta. When they are not crossed is when there are problems and that is normal. Here we also see how the blood passes, this is the perimembranous septum, it is from the aorta, and I still see that the blood does not mix, it is normal.

Here you will see what we call “3-glass plan”. This is the lung, the aorta and the cava. It is bigger than this one and this one is bigger than this one. And here the pulmonary artery is going to join the aorta, it is the ductus arteriosus which is like a little door that is going to close but until it is born, right now it is also normal for it to be open. In the left atrium you will see these little black stripes that reach the left atrium here, they are the pulmonary veins, so you are seeing the drainage of the pulmonary veins, which looks normal. And then here from the aorta, we see how the arch comes and is made, this is the aortic arch, here comes the entire aorta and is the vessel that irrigates our entire body, here I also see that there are no narrowings and that the blood is passing freely, looks normal, aortic arch fine. These are the vena cava, the inferior and the superior, which reach the right atrium, draining the cava well. And of the aortic arch, these little vessels that go upward are the ones that go towards the neck, normal. Look here comes the entire aorta. The size of the heart in relation to the size of the chest looks normal and the position normal, OK? With his little heart everything looks good.

Morphological study (Carried out in week 20)

Right now we are going to take advantage and we are going to check the rest of your organs to know that everything is fine, that we normally do this in week 20, but well, since I didn’t see you in week 20, we are going to take advantage of what we can see right now. this week. The little head, the line that divides the brain, this structure here is the thalamus and behind you can see the cerebellum which looks very good, you don’t see too much fluid inside your brain, the choroid plexuses, these are the gyri of the brain, which looks normal. Neck here. The base of the skull is fine, this little box tells me that there is a structure connecting the hemispheres, normal. The face, he is covering himself well, look how he covers his hand, his little hand, his little fingers, this would be his forehead, this would be the orbit of an eye. The orbit of the other eye, here the nose and the mouth, but look, it is completely covering its face with this little hand.

Let’s see if he takes it off now and wants to move… This way. Look how it goes through the arm, across the entire face so, this is the forehead, the eye, the other eye and this is the nose. What I’m trying to see is his lip, this is his mouth, his upper lip, his lower lip, his chin, and I’m seeing that he doesn’t have facial clefts, that he doesn’t have a cleft lip. Here’s a little eye and the nose looks, covered, covered. , well… Now it will surely move. The heart, this darker stripe that can be seen, the diaphragm, we see that it goes behind the abdomen, you can even see how it inflates and deflates, those are respiratory movements, that is good, the stomach and all this here is the liver. The colors are blood vessels, these are blood vessels inside the tummy. Your stomach that looks good. This one here that is not painted is the gallbladder, which when we see it we assume that the bile duct is formed, otherwise it could not be seen.

Since we cannot see the bile duct we see the gallbladder and downwards, in the pelvis we can see another black circle which is the bladder, which, seeing it plump, tells me that at least one of the two kidneys is working well. This is the spine, this little bean here with the black center, this is a kidney, no cysts, no tumors, it looks good and this here is the other kidney, there are no cysts, there are no tumors, perfect. Here around the bladder I put colors, I’m trying to see the entrance of the umbilical cord here to the abdominal wall, it’s this one here and see that it doesn’t have hernias, right? Large hernias. It looks normal, the abdominal wall looks intact.

And this here is the umbilical cord, here we are going to see how the blood passes through the cord. This tells us how the placenta works, how food and oxygen reach your baby and how it is normal. IP 1.14, IR 0.64, good. And here the legs look, here they kick, one little foot and the other little foot. These are the little toes of the foot and the little toes of the other foot here. And look, if it’s well covered, it’s very covered. Does not want. This is the little head, I’m here looking at the back of the neck, these streaks that you see here, it’s hair, this is already hair, this is the back of the neck here. That one here is one ear and here is the other one because it stays stuck here. The little face is there, the forehead, the nose, his mouth, eyes, cheek but very covered and in profile, but this makes us a lot of shadows, like it doesn’t cooperate much for the 4D. Because the image looks very distorted, there is his little hand and it casts a lot of shadows on us, so it is not always visible. Look, how it goes through the arm there, no. It weighs one kilo 146 grams, it corresponds to 28 weeks, it depends on the length of pregnancy. There is. But it is well covered. There he is in profile, but… He felt sorry for him! No, it doesn’t show anything. But everything is fine with your baby, okay? The important thing is that his little heart is fine, no heart disease is seen, they are growing according to the time of pregnancy, amniotic fluid is normal, the placenta is functioning well, baby, everything is fine.


Well now, as you could see in this study, the most important thing was to check the baby’s heart but if you saw, also check all his organs. She was a patient who had not had the morphological study performed, so we took the opportunity to see what she allowed us to see; his brain, his organs, his face, his arms, unfortunately he was not in a very good position to do the 4D, that’s why we couldn’t give the images of the pretty face from the 4D, of course… When the baby lends itself we give some very nice images but the important and luckiest thing about this ultrasound is that the baby’s heart is healthy. Later I want to show you a case of what a heart disease looks like, a congenital heart disease, this was detected very early, I detected it in week 20 when he came for a morphological study and we will later review it later, in week 26. 28 I will check the baby again but I already determined heart disease at week 20.

Remember the three studies: Week 11-13 chromosomal problems, week 16-23 morphological study, week 26-30 study of the little heart: Fetal echocardiography, at least I recommend those three studies. And we look forward to seeing you here with great pleasure.

“It is not exclusive to Creafam patients who come to us to carry out these types of studies, they may be patients with their external doctor or simply you decided to know how your baby is doing”

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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