Cardiology (Fetal) Referral Criteria

Any provider caring for pregnant patients. This includes obstetrician-gynecologists (OB-GYN), maternal-fetal-medicine (MFM) specialists, geneticists, radiologists, rheumatologists, cardiologists, family physicians, midwives, and nurse practitioners.

Please refer to clinical criteria below. If you are uncertain if your patient meets criteria, please submit a referral and we will advise.

For Fetal Echocardiography ≥ 18 weeks

Fetal Indications

• ALL suspected cardiac anomalies on routine screening ultrasound
• ALL suspected arrhythmias, except for isolated premature atrial contractions
• Enlarged heart
• Pericardial effusion ≥ 3 mm
• Hydrops
• High-output lesions (i.e., arteriovenous malformation/vein of Galen, tumor)
• Heart not well seen after 2 attempts
• NT >3.5 mm
• Major extracardiac anomaly (i.e., CPAM, CDH, omphalocele, kidney or lower urinary tract obstruction)
• Suspected or known inherited or de novo genetic condition (single-gene disorder, deletion/duplication syndrome, aneuploidy) affecting the heart

Maternal indications:

• Positive SSA/SSB antibodies
• Maternal diabetes with HbA1c ≥ 7.0% at time of conception
• Maternal PKU
• Maternal exposure to potential teratogens, such as lithium, retinoids, ACE inhibitors, warfarin, anticonvulsants, paroxetine (SSRI)
• Rubella, CMV, or varicella infection during pregnancy

Pregnancy Indications:

• Mono-mono pregnancy
• Mono-di pregnancy
• Acardiac twin

Family History Indications:

• 1^st degree relative to the fetus (i.e., parent, sibling, prior fetus) with congenital heart disease, including bicuspid aortic valve
• 1^st degree relative to the fetus (i.e., parent, sibling, prior fetus) with cardiomyopathy or heart transplant

Miscellaneous Indications:

• If ≥ 2 of the following “soft” indications are met: IVF +/- ICSI, NT 3.0-3.4 mm, single umbilical artery, persistent right umbilical vein
• Follow-up from early fetal echocardiography ≤16 weeks (see below)

For Early Fetal Echocardiography at 12-16 Weeks

Fetal Indications:

• ALL suspected cardiac anomalies on early ultrasound
• ALL suspected arrhythmias
• NT > 3.5 mm
• High-risk eFTS or NIPT for T13, T18, T21, monosomy X
• Non-cardiac or multiple anomalies suspected on 1^st trimester ultrasound

Maternal Indications:

• Mono-mono pregnancy
• Maternal exposure to retinoids, ACE inhibitors, paroxetine (SSRI), lithium
• Maternal diabetes with HbA1c ≥ 7.0% at time of conception
• Maternal PKU
• Rubella, CMV, or varicella infection during 1^st trimester
• Maternal exposure to lithium, retinoids, ACE inhibitors, warfarin
• Consider for BMI > 45 kg/m²

Pregnancy Indication:

• Mono-mono pregnancy

Family History Indication

• 1^st degree relative to the fetus (i.e., parent, sibling, prior fetus) with congenital heart disease, including bicuspid aortic valve

• Antenatal records
• Ultrasound reports
• Other relevant test results (NIPT, maternal antiRo/La antibodies, etc.) in current pregnancy

For urgent referrals or if you cannot access eCHN, please fax this completed referral form to (416) 813-7387.  

Contact us at fetal.cardiology@sickkids.ca or (416) 813-4914

More information can be found on Fetal Cardiac Clinic or Fetal Cardiac Program