Fetal cardiac screening: 1st trimester and beyond

Congenital heart defects (CHD) are the most common birth defect and a leading cause of infant morbidity and mortality. CHD often occurs in low-risk pregnant patients, which underscores the importance of routine fetal cardiac screening at the time of the 2nd trimester ultrasound. Prenatal diagnosis of CHD is important for counseling and decision-making, focused diagnostic testing, and optimal perinatal and delivery management. As a result, prenatal diagnosis has led to improved neonatal and infant outcomes. Updated fetal cardiac screening guidelines, coupled with technological advancements and educational efforts, have resulted in increased prenatal detection of CHD in both low- and high-risk populations. However, room for improvement remains. In recent years, fetal cardiac screening for specific high-risk populations has started in the 1st trimester, which is a trend that is likely to expand over time. This review discusses fetal cardiac screening throughout pregnancy. What is already known about this topic?Routine ultrasound screening is essential for the prenatal detection of congenital heart defects (CHD). Fetal cardiac screening remains suboptimal.What does this study add?The latest guidelines for 2nd trimester fetal cardiac screening from different professional societies are reviewed. The use of cine loops, color Doppler, and 1st trimester screening is encouraged to improve prenatal detection of CHD.