The fetal cardiology team specialise in diagnosing and treating
children's heart problems before birth
Congenital heart disease (CHD) is common with approximately 1000
babies born each year leaving hospital with a cardiac defect
undetected, and around 15% of these being life threatening. Most of
these cardiac defects occur in low risk pregnancies and it is the
role of the antenatal screening programmes fetal anomaly screening
pathway programme (FASP) to try to identify those pregnancies
affected before birth.
Many congenital heart conditions (CHD) can be identified before
birth with an ultrasound scan (fetal echocardiogram) although some
conditions remain difficult to detect.
Early antenatal detection of congenital heart defects offer
these woman the opportunity for accurate diagnosis and counselling.
Appropriate management and planning of these pregnancies can
therefore offer better outcomes for these babies and their
families.
For more information on fetal cardiology, please visit the South
West Fetal Medicine Network
website.
What is fetal echocardiography?
Fetal echocardiography is a test using sound waves (ultrasound)
which allows the sonographer or doctor to better see the structures
of your unborn babies' heart.
Not all pregnant woman need a fetal echocardiogram, for most
woman the basic fetal anomaly screening programme (FASP) Physical
examination which is performed between 18-20+6 weeks will show the
normal development of your babies heart. Sometimes this routine
pregnancy ultrasound scan will detect a fetal heart abnormality and
you would be recommended to have a fetal echocardiogram.
You may also need the test if:
Some pregnant women are at a slightly increased risk of giving
birth to a baby with congenital heart disease (CHD). They should be
considered for referral for a specialised fetal echocardiogram.
Indications may include some of the following:
- A first-degree relative of the fetus with CHD.
- An abnormal fetal heart rhythm
- A Nuchal translucency of >3.5mm
- An abnormality of another major organ system
- Maternal diabetes mellitus (insulin-dependent)
- Exposure to some drugs in early pregnancy, for example, some
anti-epileptic drugs.
- Abnormal fetal karyotype
- Monochorionic twins
- Maternal Anti Ro/La antibodies
Location
Clinics are held in the fetal medicine Unit - Level E, St
Michael's hospital in Bristol.
About your appointment
You will be contacted by the fetal cardiology administrators
with a date and time for your appointment. Please bring your
maternity notes with you.
When you arrive, please check in to the main ultrasound
department on Level E, St Michaels' hospital and you will be asked
to take a seat in the waiting room until you are called through to
the scan room.
What will happen during my appointment?
This scan is similar to the routine anomaly ultrasound scan you
have for your baby, except that it will concentrate on examining
your baby's heart and looking at it in greater detail.
We do not assess any other features of the baby's anatomy and
therefore we are unable to comments on previous scans you may have
had, this includes the sex of the baby.
How long will my appointment take?
As a guide, the scan may take around 30 minutes however the scan
time may vary depending upon your baby's position and the heart
problem detected and it may take up to 45 minutes to complete. It
is similar to any other type of ultrasound scan and does not cause
harm to your baby.
Each appointment is tailored according to individual needs.
Sometimes this may cause delays to your appointment time. We
appreciate that this can be a stressful time for you and we
apologies for this in advance.
It is not necessary to have a full bladder for this scan.
Who will be present during my scan?
The fetal cardiology team consists of a consultant fetal
cardiologist, a fetal cardiac sonographer and a cardiac nurse
specialist who are all usually present during your
consultation.
The scan is usually performed by the fetal cardiac sonographer
or fetal cardiologist, however at times it may be performed by one
of the trainees, under consultant supervision.
As a major teaching hospital, it is possible other healthcare
professionals may be present. No more than 4 people are usually
present in the room, unless in special circumstances when you would
be asked for your consent.
Please let us know if you would rather not have extra people
present.
How will I get the results of the scan?
If your baby is found to have heart condition, the fetal
cardiologist will explain to you:
- The exact nature of the heart condition found.
- The likely treatment that may be needed after birth.
- The overall prognosis and long term outlook.
- The options available to you and the implications for your
pregnancy.
You will have time to ask questions to clarify anything that you
may not have understood during the discussion. Do not worry if you
think of more questions after the appointment - you will be given
contact details for the cardiac nurse specialist who will provide
support to you.
Ultrasound recording
The scan of your baby's heart will be recorded and images stored
securely on the hospital system. These images remain
confidential at all times, but may be used to discuss with other
specialist involved in your care as well as for audit and teaching
purposes.
As far as possible personal details are restricted to maintain
privacy and all images are kept on the hospital database.
During your visit, you will be asked for your consent for the
images being used for teaching purposes. All images used for
these purposes will be anonymised.
Please note we will not be able to provide recordings for your
own personal use.
We accept referral from obstetricians, midwives and GP's
To refer to fetal cardiology please download the fetal
cardiology referral form,
The new referral form and referral criteria along with further
information about our fetal cardiac service is also available on
our website: /fetalcardiology
The future
This department contributes information to The National
Congenital Anomaly and Rare Disease Registration Service (NCARDRS)
& National Institute Cardiac Outcome Research (NICOR). The
benefits of this include:
- Detection of birth abnormalities in the same area.
- Monitor the scanning and detection services you receive during
pregnancy.
- Evaluate the necessary facilities provided in the hospitals and
community services.
- Contribute to research questions about specific abnormalities
such as cardiac defects.
Finally…
We hope that your visit to the fetal cardiology department will
be helpful and we will endeavor to answer all your questions. If
you have any questions regarding your appointment, if you are
unclear about what was said or are unhappy about anything that has
happened during your visit, please contact the fetal cardiology
team.
Meet the fetal cardiology team
The fetal cardiologists and sonographers provide training across
the South West for sonographers to improve their ultrasound skills
as well as participating in research studies.
The consultants:
Dr Patricia Caldas - Consultant Fetal and
Paediatric cardiologist, lead for the fetal cardiology service and
Clinical Lead for the Paediatric Cardiology Department at Bristol
Royal Hospital for Children.
Dr Caldas trained in paediatric cardiology in Portugal. She
has a post-graduation course in Sports Medicine. She worked at John
Radcliff Hospital in Oxford and has been working at Bristol Royal
Hospital for Children since 2015.
Dr Caldas is leading a pioneering project on online education in
fetal cardiology across the SW England.
Dr Camilla Snook - Consultant Paediatric
and fetal cardiologist.
Dr Camilla Snook trained in Paediatric Cardiology in Bristol.
She completed her specialist training in Fetal Cardiology at the
Royal Brompton Hospital, London, and has been a Consultant in
Bristol since 2018.
Dr Ines Gomes - Consultant Fetal and
Paediatric cardiologist
Interests/Expertise/research in CHD
Fetal cardiology, Pulmonary Hypertension cardiovascular risk
prevention, cardiac congenital rehabilitation.
Consultant Paediatric Cardiologist since 2015, in Lisbon. Did
several courses and an internship in Cardiac Morphology in
University College (London) and fellowships in Great Ormond Street
Hospital (London) and in Hospital Gregorio Maranon (Madrid).
Completed post-graduation in Sports Medicine and Harvard Medical
School - Portugal training, Clinical Scholars Research
Training. Participation in several European Meetings,
presenting research and moderating sessions. Implementation of
Cardiovascular Assessment clinic and Research in Dyslipidaemia in
Lisbon.
Fetal Cardiologist since 2015, working in large volume tertiary
Fetal Medicine Centre.
Moved to Bristol in June 2019, continued to work as Fetal
Cardiologist and currently also responsible for liaising with
National Pulmonary Hypertension Centre in Great Ormond Street
Hospital.
Dr Andy Tometzki - Paediatric consultant
cardiologist South Wale and South West congenital network lead
Dr Tometzki is a Consultant Paediatric Cardiologist with
specialist interest in Cardiac Catheter Intervention and Fetal
Cardiology. He studied medicine at Sheffield University Medical
School qualifying in 1985. He trained in several major cardiac
centres in the UK as well as University of California Medical
Centre, San Francisco. He has been a consultant since 1999
initially in Edinburgh moving to Bristol later the same year. Dr
Tometzki holds an Honorary Senior Lectureship in Child Health at
the University of Bristol.
Dr Tometzki also holds the following national positions:-
- Chair of the Clinical Reference Group on Congenital Heart
Services to NHS England.
- Specialist Advisor by the Care Quality Commission
Dr Mari Nieves Velasco - Specialist
registrar in paediatric cardiology
Dr Mari Nieves Velasco trained in Paediatrics in Spain, in
Seville University Hospitals. She then did a clinical fellowship in
Paediatric Cardiology in the Evelina Children's Hospital in London
and a Research Fellowship in cardiac MRI in King's College London
University at St Thomas' Hospital, where she was involved in
multiple research projects including 3D printing and MRI
catheterisation in patients with Congenital Heart Disease. She
worked as a cardiology registrar in the Children's Hospital in
Queen Elizabeth University Hospital in Glasgow and then continued
her training in Bristol Royal Hospital for Children. She is now a
fetal cardiology trainee in Bristol.
Fetal Cardiac Sonographers:
Angie Hobbs - Fetal cardiac and Midwife
sonographer
Angie Hobbs worked as a Midwife sonographer at North Bristol
Trust before moving to the Bristol Children's hospital and
specialising as a fetal cardiac sonographer in 2012. She attended
the University of
the West of England where she gained an MSc with Distinction in
Medical ultrasound.
Jo Jones - Cardiac Physiologist
Jo Jones is a Cardiac Physiologist who has specialised in
Congenital Heart Disease.
Jo works as a BSE and EAE accredited sonographer specializing in
both Fetal and Paediatric echocardiography. Jo also provides
lecturing on congenital heart disease at the University of the West
of England and is currently enrolled on a Health Education England
supported professional doctorate to achieve Higher Scientific
Specialist Training (HSST) as a consultant clinical scientist.
Cardiac nurse specialists:
The Fetal CNS team work as part of a dynamic team of expert
cardiac practitioners. In their role, they are engaged throughout
the patient pathway from antenatal care to transition to adult
services. Their niche role involves meeting families at all points
in their care pathway.
The team is highly competent, knowledgeable and visible
practitioners who ensure the provision of appropriate evidence
based information and support to patients during their fetal
journey. They act as an approachable resource for colleagues,
families, and other agencies whenever needed, linking closely with
local community teams and supporting effective communication.
From a patient perspective, you are likely to meet with the team
throughout your fetal cardiac journey. The CNS team aims to support
patients and families with decision making following diagnosis as
well as undertaking preparatory work in readiness for delivery.
Lisa Patten - Paediatric Cardiac Nurse
Specialist
- Interests/Expertise - Fetal Cardiology (current lead on behalf
of the CNS team), Paediatric Warfarin Management. Lisa is
also the current Lead for the Paediatric CNS team as a whole.
- Lisa has being working with the congenital cardiac team since
2004, bar a short spell spent with the University of Bristol
research team, and has been in her current role of Cardiac CNS
since 2011.
Diane Barlow - Paediatric Cardiac Nurse
Specialist
- Interests /Expertise - Fetal Cardiology, Inherited cardiac
disease & Arrhythmia.
- In 2010, Diane was appointed into her current role as Cardiac
CNS having relocated from Great Ormond Street Hospital. She
brought with her a wealth of experience from her years of practice
in paediatric congenital/inherited cardiac care.
Jessica Hughes - Paediatric Cardiac Nurse
Specialist
- Interests/Expertise - Fetal Cardiology, Transition. Jess
also spends some of her working week as part of the SWSWCHD Network
Team.
- Jess joined the CNS team in 2011 following a background in
Paediatric acute care (PICU/A+E). She has also recently
joined the SWSWCHD Network team as lead nurse on a part-time
basis.
Ella Houghton - Paediatric Cardiac Nurse
Specialist
- Interests/Expertise - Fetal Cardiology, The Inpatient Pathway,
Paediatric Warfarin Management
- Ella joined the team in 2017 from her previous position on the
paediatric cardiac ward.
Naomi Jones - Paediatric Cardiac Nurse
Specialist
- Interests/Expertise - Fetal Cardiology, The Elective Admission
Pathway
- Naomi has been part of the CNS team for 5+ years having joined
with a varied background from Paediatric Intensive Care, Paediatric
Oncology and Cardiology.
Administration
Adam Cockle - Senior administrator
Sania Robinson - Data collection officer
Contact us
If you have any further concerns, please discuss these with your
local obstetric team or the fetal medicine midwives or fetal
cardiology at St Michael's Hospital on:
Fetal Cardiology - 0117 34 25394
Monday - Friday, 8.30 am - 4.30 pm
www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/st-michaels-hospital/
Cardiac Nurse Specialist - 0117 342 8286 / 0117 342 8578
cardiacnurses@uhbw.nhs.uk
Monday to Friday - 8am to 4pm
Other sites, which you may find useful, are:
South Wales and South West Congenital heart Disease
Network
Website:
www.swswchd.co.uk
Bristol Royal Hospital for Children
Website:
www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/bristol-royal-hospital-for-children/childrens-website
Facebook:
www.facebook.com/bristolroyalhospitalforchildren
Antenatal results and choices: www.arc-uk.org/
British Heart Foundation
Website:
www.bhf.org.uk/
Arrhythmia Alliance
Telephone: 01789 867501
E-mail:
info@heartrhythmalliance.org
Website:
www.arrhythmiaalliance.org.uk
Facebook: www.facebook.com/ArrhythmiaAlliance/
Support Groups
Heart Families South West
Telephone: 07929 261 121
Facebook: www.facebook.com/HeartFamiliesSouthWest
Heart Heroes
Telephone: 07951 835360
Website: www.heartheroes.co.uk
Facebook: www.facebook.com/heartheroesglos/
Location: The fetal cardiology department is on Level E of St
Michael's Hospital.
