2d echo test in pregnancy

Performing a 2d echo test during pregnancy is not uncommon.  A 2d echo test may be required for the mother or the baby during pregnancy. It is pretty common to get anxious about going to a 2d echo test during pregnancy. This article discusses the need for a 2d echo test during pregnancy.

What is a 2d echo test?

 

Echocardiography with Doppler uses ultrasound technology to give your doctor a live-moving picture of your heart. 2d echo test with Doppler helps detect a variety of heart-related disorders in the mother or baby.

Scanning the baby’s heart got a unique name, fetal 2d echo.

 Is there any radiation with the 2d echo test

The first thing that comes to mind of a pregnant mother is concern about radiation to the baby. Unlike x-ray and ct scans, the echocardiogram test has no associated radiation. But, an echocardiogram employs ultrasound, or non-harmful sound waves, to acquire crucial information about the heart. Therefore, 2d echocardiography is completely risk-free both for the mother and the baby. 

What to expect during a 2d echo test during pregnancy?

 

The doctor will explain the 2d echo procedure to you and allow you to ask questions. In most cases, no prior preparation is required.

For a 2d echo test, your doctor asks you to lie down on the hospital bed or table. To do a 2d echo test on the mother’s heart, the doctor keeps the probe on the mother’s chest.

The probe is placed over the mother’s abdomen to look for the baby’s heart during a fetal 2d echo test.

 

Why does a mother with pregnancy need a 2d echo test?

 

There are several indications that a mother needs a 2d echo test. Cardiac diseases complicate about 1 to 4 percent of pregnancies. These women need a 2d echo test to establish the diagnosis and manage the problem. 

Your doctor advises a 2d echo test during pregnancy if you have the following symptoms

1. Chest pain
2. Breathing difficulties
3. Swelling in the feet

  2d echo test is also recommended when the pregnant woman has a  history of heart disease before pregnancy.

If high blood pressure or diabetes complicates the pregnancy, a 2d echo is often advised to the mother.

The most frequent form of heart illness in pregnant women is rheumatic heart disease in India. Mitral valve stenosis is the commonest form of rheumatic heart disease. 2d echo test is the test of choice to diagnose mitral stenosis and quantify the severity.

Congenital heart disease is also the most frequent type of heart disease that causes pregnancy complications. Atrial septal defects are the commonest form of adult Congenital heart disease. 2d echo helps assess the size and impact of atrial septal defects. 

Many women put off having children until their fourth or fifth decades. Pregnancy after 35 years can lead to an increase in heart diseases complicating the pregnancies. Underlying medical disorders like hypertension, diabetes, and hypercholesterolemia grow more common as mothers get older, increasing the risk of heart disease during pregnancy. Such women may need a 2d echo whenever they develop symptoms of heart disease.

  Swelling of the feet is quite common in the last trimester. It can be a normal finding or a sign of severe heart disease.  One of the difficulties for the cardiologist is distinguishing between these typical indications of pregnancy and similar symptoms that could suggest the mother’s underlying heart problems. 2d echo test is a commonly prescribed test to differentiate normal from abnormal 

 Prior viral infections, HIV infection, or drugs can cause ventricular failure in women’s reproductive years. When a woman with ventricular failure plans to conceive, she needs to evaluate baseline heart function with a 2d echo test. Pregnancy should be avoided if heart function is significantly reduced (ejection fraction less than 45 percent). The ejection fraction measures the strength of the heart.

 Sometimes, patients with known or suspected left ventricular dysfunction conceive accidentally; echocardiography should be done soon. These women need careful follow-up with a cardiologist and frequent testing with a 2d echo.  

  Peripartum cardiomyopathy is a heart muscle weakness that develops during pregnancy. This happens in a few women in their last trimester of the first six months after delivery. They are no identifiable causes for their heart failure other than pregnancy. Wone with Peripartum cardiomyopathy presents with shortness of breath and swelling of the feet. The 2d echo test reveals weakness of the mother’s heart muscles in peripartum cardiomyopathy. These women need treatment for their heart failure.

In women with hypertrophic cardiomyopathy, pregnancy is often successfully tolerated. We, cardiologists, allow them to conceive. Such women need careful assessment of heart function with 2d echo.

It is not uncommon for women with Prior heart attack, percutaneous coronary interventions (PCI), coronary artery bypass surgery, and CAD to conceive. Before pregnancy, baseline heart function should be assessed with a 2d echo. They also need regular cardiologist checkups with frequent 2d echo testing. 

Heart transplant recipients have reported having successful pregnancies. They, too, need frequent 2d echoes during and after pregnancy.

 Arrhythmias and conduction abnormalities can occur before or during pregnancy. The cause of Arrhythmias or heart rhythm abnormalities is identified by ECG, 2d echo test, and Holter tests.

What are the indications for fetal 2d echo test during pregnancy?

 

The optimal gestational age for a fetal 2d echo test is 18 to 22 weeks. At this point of pregnancy, fetal heart anatomy can be seen well. 

 Indications for fetal 2d echo test are many, and few are mentioned here.

Diabetes mellitus or sugar complicating the pregnancy can cause heart defects in the baby.  Such ladies need a fetal 2d echo test.

Specific autoantibodies in the mother (SSA/SSB) are known to cause heart disease. When a woman has such autoantibodies in the blood, she should get a fetal echo for her baby during pregnancy.

Use of possible teratogens by mothers during pregnancy that causes heart diseases in the baby (e.g., thalidomide, angiotensin-converting enzyme inhibitors) – These women need fetal echo tests for their baby.

Rubella infection in the mother, especially in the first three months of the pregnancy, can lead to heart defects in the baby. Such mothers are often advised to undergo a 2d echo test to check whether the baby is affected.

 Fetal echo is recommended in the mothers affected with Coxsackievirus, adenovirus, parvovirus B19, and cytomegalovirus infections that may affect the baby’s heart. 

When a typical obstetric ultrasound examination reveals a fetal noncardiac anomaly, a 2d echo test of the bay is the next step to rule out associated heart defects.

Fetal hydrops is a potentially fatal disorder. It happens when a fetus or infant has abnormal quantities of fluid in two or more bodily locations. It is an indication of more severe heart issues. 2d echo tests help to know associated heart problem

When the fluid gets collected around the baby’s heart, it is referred to as pericardial effusions. It is suspected when a routine antenatal ultrasound scan identifies the fluid.

When this abnormality is detected, your doctor advises you to undergo a fetal echo to know the underlying heart diseases responsible for the fluid accumulation.

Other indications for fetal 2d echo test are:

 1. Pregnancy conceived with IVF technology (as it is known to be associated with heart problems in the baby).   

2. Congenital heart disease in a fetus’s first-degree relatives (Noonan syndrome, tuberous sclerosis, Holt-Oram syndrome, velocardiofacial syndrome, Alagille syndrome, Williams syndrome)

3. If a fetal cardiac anomaly is suspected on a typical obstetric ultrasound examination, thorough scanning of the baby’s heart is needed with a fetal 2d echo test.

4. Heart rhythm abnormalities suspected in the baby during examination by the treating doctor

5. Monochorionic twins- When twin babies share a single placenta, the possibility of heart defects is high.

 

What is the cost of 2d Echo test in pregnancy?

 

Echo test in pregnancy to the mother’s heart costs similar to a basic 2d echo test. 2d echo test can cost you 1000 to 2000 rupees in India.
Fetal 2d echo test is relatively expensive and typically ranges from 2500 to 5000.

Which 2d echo tests are not done in pregnant women?

 

A stress 2d echo test is a special type of 2d echocardiogram where scanning is done when the heart is under stress. It carries some risk and is not done for the mother.

Can TEE 2d echo test be done during pregnancy?

 

Yes. TEE test is another type of 2d echo test where a probe is passed through the mouth into the food pipe. It is safe in pregnancy, But its application in pregnancy is very rare.