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Considerable advances in ultrasound technology and close collaboration between the specialties of paediatric cardiology and fetal medicine have resulted in the increasing ability to diagnose congenital heart disease before birth over the last two decades. Fetal cardiology differs from paediatric cardiology not only in the spectrum of diseases seen, but also in the assessment of function because of the extended feto-placental circulation. Importantly, outcomes for specific lesions may differ as extracardiac abnormalities and chromosomal defects may alter the prognosis of otherwise straightforward cardiac lesions such as tetralogy of Fallot.1 Historically the examination of the fetal heart and circulation developed separately, obstetricians using Doppler to examine the uteroplacental circulation to study the pathophysiology of pregnancy,2 3 while cardiologists focused their attention on the morphological aspects of cardiac development using M mode and Doppler.4 5 In today's practice a comprehensive evaluation of the fetal cardiovascular system includes both structural and functional assessment using new technologies to monitor the progression of cardiac defects and to aid management decisions such as the need for early delivery, treatment of arrhythmia or for interventions such as balloon valvuloplasty of semilunar valve obstruction.
The underlying problem
Congenital heart disease affects 6–8 per 1000 live births, at least half of which should be detectable before birth because of their serious nature. However, if examination of the fetal heart is confined to traditional high risk groups only about 20% of babies born with congenital heart disease will be identified (table 1). Therefore the focus must be to examine all pregnancies for cardiac malformations. The opportunity to do so is present in some centres at 11–14 weeks when nuchal fold thickness is measured to assess the risk of chromosomal defects in the fetus. However, in the UK most pregnant women are assessed for the first time in detail by sonographers …