Fetal cardiology

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