February 7th thru the 14th is Congenital Heart Defect Awareness Week. Did you know that heart defects are the most common type of birth defect? It happens to 40,000 births each year, and is the leading cause of infant death in the US. Heart defects can range from very mild to very severe. Most causes of heart defects are unknown; some are due to changes in chromosomes, and some are due to a combination of factors such as environment, medications, and maternal health problems. Some heart defects are mild and will resolve without any medical procedures. Up to 25% of heart defects are very severe and will require medical procedures.
When you are coming in for your first new obstetrical visit, we take a detailed history. As my professor in medical school once said, “The answer is in the history.” If there is anything in your history that may suggest a risk for any birth defect or chromosomal issue, we will recommend that you see a specialist such as a perinatologist (high risk obstetrical doctor) and/or a geneticist for further evaluation.
As your pregnancy advances, we send all women for an ultrasound around the 20th week. The purpose of this visit is to look at the baby’s organs. Ultrasound picks up about 90% of major malformations. There are certain views that we must get in order to properly see the organs, especially the heart. The heart is very small, and at times is hard to get certain views. This may be due to positioning of the baby or may be due to the ultrasound machine not being able to pick up the sound waves properly. Sometimes, we send women for more a more advanced ultrasound called fetal echocardiography. This is done because of the medical history or genetic testing or because of what we found on the first ultrasound.
Either ultrasound can take up to 2 hours to complete. If you have small children with you, it may help to bring attendants who can take care of the little ones for you.
One limitation of ultrasounds I’d like you to know is that some heart defects are very small and just can’t be picked up by the ultrasound. On occasion, an ultrasound may show an echogenic focus or spot on the heart which can be of no significance.
Severe heart defects place the baby in a precarious medical state and place families in an extreme emotional and financial state. If you find that your baby has a congenital heart defect, there are programs to help you through it all. The American Heart Association has on their website a category devoted to congenital heart defects.
One final note….many babies born with severe heart defects can survive due to advances in medicine. It is estimated that 1 million adults are living with a congenital heart defect. Those adults with a congenital heart defect may only need an occasional check up and some may need long term specialized medical management. Many babies born with heart defects today not only survive, but live long and productive lives.
Cynthia Wilkes MD
Stafford Womens Health Associates