Both Dr Gladman and Dr Jones, Fetal Cardiologists, are based at Alder Hey Children’s Hospital in Liverpool where all the surgery and intervention are provided for the North West, North Wales and Isle of Man region. They diagnose and treat children with a wide range of heart problems but also specialise in fetal cardiology.
The fetal cardiologists, in conjunction with the specialist midwives from Saint Mary’s Hospital and specialist nurses from Royal Manchester Children’s Hospital, work together to provide support for families throughout the pregnancy.
Conditions dealt with
Many congenital heart conditions (CHD) can now be picked up before birth by performing a detailed scan (fetal echocardiogram), though some conditions remain difficult to detect.
You may be referred to the team for an echocardiogram after your sonographer had suspected a problem on the routine 20 week scan. We see a wide range of problems that can develop when the heart is not formed properly early in pregnancy. Many congenital heart problems can be treated, usually with surgery to repair the heart and create a normal circulation. However, there remain a number of complex CHD where we cannot fix the heart, but only offer surgery to re-direct the blood and use the heart in a different way. In rare severe cases there may be no treatment possible.
A proportion of babies diagnosed with CHD may have an underlying genetic or chromosomal problem or other abnormalities in other parts of the body. When we see a significant heart problem we usually recommend a detailed scan with a fetal medicine specialist to check the rest of the baby and often discuss the option of an amniocentesis test to look for genetic problems.
For pregnant women at slightly higher risk of having a baby with CHD, a specialist echocardiogram is also recommended. For families where the mother, father or a previous child has a congenital heart condition, this can be a worrying time. After assessment, we can, in many cases, reassure the family that the baby’s heart is normal. In a small number of cases a problem with the heart may be detected.
What is offered to patients?
Following a diagnosis of CHD our team will then explain the diagnosis, further tests that might be recommended or offered and discuss all options with the family.
Pre-natal diagnosis gives time for the family to learn more about the heart condition and prepare themselves for the treatment or surgery that might be required after birth. Following repeat assessments we can then decide on the best place to deliver the baby, depending on their heart problem and whether early treatment may be required in the first hours or days after the baby is born. This means that we can keep the baby as safe and well as possible prior to any treatment or surgery they may require.
We work closely with the cardiac specialist nursing team at Royal Manchester Children’s Hospital, who can arrange to meet up with families to discuss diagnosis and treatment and support parents before and after their baby is born. Where early surgery is required, some families may want to visit the surgical centre, Alder Hey in Liverpool and meet with the cardiac team.
What else?
Congenital heart care and treatment in the UK is monitored nationally and this information is collected centrally by NICOR (National Institute for Cardiovascular Outcomes Research). They are now beginning to collect information on which heart conditions are diagnosed before birth; it is hoped that this will help improve pre-natal diagnosis rates across the country.
The fetal cardiologists provide training across the North West for sonographers to improve skills as well as participating in research studies.
Location
Clinics are held in the Fetal Medicine Unit (within the Ultrasound Department) at Saint Mary’s Hospital in Manchester.
How can I access this service?
Your local obstetrician, midwife, sonographer, cardiologist or GP can refer you for a specialist fetal echocardiogram by contacting the specialist midwives at the Fetal Medicine Unit on (0161) 276 6385.
About your appointment
You will be contacted by the fetal medicine staff with a date and time for your appointment. Please bring your green handheld notes with you.
When you arrive please check in at the main Ultrasound reception at Saint Mary’s Hospital and you will be asked to wait in the Fetal Medicine waiting area.
You may be referred to the fetal cardiology team because the sonographer has found a problem with the baby’s heart or been unable to get good views during your 20 week anomaly scan. If you are at slightly higher risk of having a baby with a heart problem you may also be referred for a fetal echocardiogram.
Fetal echocardiogram
You will be first called through for a scan of the baby’s heart (fetal echocardiogram). This is a detailed scan where all the valves, vessels and blood patterns in the heart are checked, as well as the heart rhythm. Scan time may vary depending on your baby’s position and the heart problem detected and may take up to 45 minutes to complete. It is similar to any other type of ultrasound scan and doesn’t cause any harm to you or the baby. It is not necessary to have a full bladder for this scan.
The scan will usually be performed by one of the fetal cardiology or fetal medicine consultants, but may be done by one of the trainees under consultant supervision. Whoever is doing the scan may be fairly quiet while they are scanning. This is because they will be concentrating on getting all the information.
When the scan is finished if there are any problems detected, the consultant will explain exactly what the heart problem is and what treatment or surgery may be possible after the baby is born. They will often arrange another scan to check over the rest of your baby and may offer the option of an amniocentesis test to look for any underlying causes. The team will discuss all options available. Feel free to ask as many questions as you need to at this point.
A written report about the heart problem that has been detected will be documented in your green hand held notes.
After the appointment
If a problem is found this can be difficult information and often families want to go home and discuss their options in more detail. We will provide contact details for the specialist midwives to discuss things further.
If a heart problem is detected, meeting one of the specialist nurses from Royal Manchester Children’s Hospital is often very helpful in providing more information and support for families throughout the pregnancy. Searching the internet is often misleading, but we can recommend some local and national charities to search out more information and support; these can be found in the ‘Where can I get more information and support’ leaflet on the website.
In most cases, where a heart problem is detected this does not cause major problems for the baby in the womb as the mother’s placenta is providing the oxygen and supporting the circulation. It is very important that you continue to look after yourself and attend all the normal pregnancy appointments at your local hospital.
Follow-up appointments
Following diagnosis we will usually see most families later on in the pregnancy. This is a good opportunity to ask further questions and talk about planning the delivery and treatment after birth. Another scan will be performed to check over the heart again and look for any changes as the heart has grown.
Following this appointment a care plan will be made detailing what checks or treatment is needed after your baby is born. If you are delivering at your local hospital this care plan will be sent over to the delivery team and paediatric doctors.
For babies with more complex heart problems, we may recommend that your baby is born at Saint Mary’s Hospital and cared for on our Newborn Intensive Care Unit (NICU) and reviewed by the cardiologist. If surgery is required then the family can transfer to Alder Hey Children’s Hospital in a planned way within the first couple of weeks. In a small number of cases where early surgery is required then it may be planned that the baby is born at Liverpool Women’s Hospital.
Contacting the Fetal Cardiology Team
Saint Mary’s Hospital
Fetal Medicine Unit – (0161) 276 6385:
- Consultant Fetal Cardiologists – Dr Gordon Gladman*; Dr Caroline Jones*
- Clinical Lead Fetal Medicine – Dr Phil Bullen
- Specialist Midwives – Lynn Kirby; Della Carr; Jen Easton
Royal Manchester Children’s Hospital
Cardiac Liaison Nursing Team – (0161) 701 0664
- Clair Noctor; Tessa Latimer; Laura Jole
Alder Hey Children’s Hospital
Cardiac Liaison Nursing Team – (0151) 252 5291
- Gill McBurney; Mary Murray; Helen Walker; Amanda Haworth; Marie Murphy; Michelle McLaren
Liverpool Women’s Hospital
Fetal Medicine Unit – (0151) 702 4072
- Consultant Fetal Cardiologist – Dr Joyce Lim*
- Clinical Lead Fetal Medicine – Dr Devender Roberts
- Consultant in Fetal Medicine – Dr Umber Agarwal
*All the fetal cardiology consultants are currently based at Alder Hey but can be contacted through the specialist midwifery team or specialist nurses to arrange a further consultation or to discuss questions.