Fetal Cardiology Consultation Note

Fetal Cardiology Consultation Note

Encounter Date: [Date]

Encounter Type: [in-person / telehealth / inpatient consult / outpatient consult]

Consulting Clinician: [Name, credentials]

Referring Clinician: [Name, specialty, practice]

Primary OB/MFM (if different): [Name, specialty, practice / Not in referral records]

Location: [Clinic / Hospital / Telehealth originating site]

Interpreter: [Not used / Language and interpreter ID]

Persons Present: [Patient alone / partner / family / learner / other]

Patient/Fetal Identification

Maternal: [Full name] | [DOB] | [MRN]

Pregnancy Type: [singleton / multiple]

Fetal Sex: [male / female / unknown / not assessed]

(For multiple gestations, include explicit labeling basis and repeat fetus-specific details throughout the note:)

• Fetus A: [Labeling basis: position relative to cervix / maternal laterality / sonographer designation] | Fetal Sex: [male / female / unknown / not assessed]
• Fetus B: [Labeling basis] | Fetal Sex: [male / female / unknown / not assessed]

Reason for Consultation

Referral indication: [Referrer-stated indication using their wording when available]

Clinical question(s): [Specific question(s) to be answered, e.g., confirm suspected CHD, risk stratify for delivery, evaluate arrhythmia]

Triggering finding(s): [Abnormal screening ultrasound / family history / maternal condition / genetic result / fetal arrhythmia / routine screening—state rationale if no defined risk factor]

Pregnancy Overview

Gestational Age on Date of Study: [weeks + days / Unknown]

Estimated Due Date: [EDD] | Dating method: [LMP / first-trimester ultrasound / Unknown]

Gravidity/Parity: [GxPy or GTPAL] (Include prior outcomes relevant to CHD/genetics.)

Chorionicity/Amnionicity: [DC/DA / MC/DA / MC/MA / N/A / Unknown] (For multiple gestations.)

Pregnancy Complications to Date: [Hypertension / diabetes (type) / growth restriction / infections / other / None / Unknown]

Records Reviewed

• [Referral documents] — [Date]
• [MFM/OB notes] — [Date]
• [Anatomy scan report] — [Date]
• [Prior fetal echocardiogram reports] — [Dates]
• [External imaging: images reviewed / report-only] — [Source, Date]
• [Patient-reported history source] — [e.g., interview today / patient intake form]

Maternal History

• Medical conditions: [Diabetes (type) / autoimmune disease / PKU / thyroid disease / hypertension / maternal CHD / cardiomyopathy / arrhythmia / other / None / Unknown]
• Medications and exposures: [Prescription medications / teratogens / substance use / ART / supplements / None / Unknown]
• Allergies: [NKDA / List agents and reactions / Unknown] (Note relevance if maternal antiarrhythmic therapy may be needed.)
• Family history (first-degree): [CHD / syndromes / sudden death / arrhythmias / None / Unknown]
• Genetic testing status: [Screening vs diagnostic / results / pending / declined / Not in referral records]

(If history unavailable, state: "Maternal history limited by records available today.")

Fetal/Obstetric Context

• Extracardiac fetal findings: [None identified / suspected anomalies / syndromic features / Unknown]
• Placental/cord concerns: [Previa / accreta spectrum / velamentous insertion / other / None / Unknown]
• Growth and amniotic fluid: [EFW percentile / growth trend / AFI or DVP / oligohydramnios / polyhydramnios / Unknown]
• Fetal well-being concerns: [Hydrops / decreased movements / BPP/NST abnormalities / suspected compromise / None / Unknown]

Fetal Echocardiography – Study Details

Study type: [Complete / follow-up (limited)] | [Performed today / outside study reviewed]

Technique: [Transabdominal / transvaginal] | [2D / color Doppler / spectral Doppler / M-mode]

Image quality: [Adequate / suboptimal] (If suboptimal: [fetal position / maternal habitus / late GA / oligohydramnios / acoustic shadowing / other])

Fetal lie/presentation: [Cephalic / breech / transverse / oblique] | Cardiac axis/position: [Degrees / leftward / rightward / midline / Not assessed]

Fetal Echocardiography – Findings

Executive Summary: [3–6 sentence synthesis: GA and study adequacy; primary diagnosis or "normal fetal echocardiogram"; highest-impact physiology (ductal dependence, atrial septal restriction, significant regurgitation, hydrops); limitations and cannot-exclude statements if applicable.]

Anatomic Findings (Segmental Analysis)

(For each structure: Normal / Abnormal with description and clinical implication / Not visualized / Not assessed / Indeterminate)

• Situs and cardiac position: [Visceral situs, cardiac position, cardiac axis]
• Systemic venous return: [IVC, SVC, hepatic veins, ductus venosus]
• Pulmonary venous return: [At least one right and one left PV when feasible; obstruction or anomalous connection if present]
• Atria and atrial septum: [Atrial situs; foramen ovale shunt direction; restriction: none / possible / likely]
• Atrioventricular connections and valves: [Concordance; mitral/tricuspid morphology; regurgitation or stenosis with severity]
• Ventricles: [Size balance; septal integrity with VSD type if present; systolic function]
• Ventriculoarterial connections and outflow tracts: [Concordance; overriding; outflow tract patency]
• Semilunar valves: [Stenosis/regurgitation; annulus size if measured]
• Great arteries and arches: [Aortic arch sidedness; coarctation markers; ductal arch patency and flow direction]
• Pericardium and pleural spaces: [Effusions; cardiomegaly]
• Rhythm and conduction: [Rate; regularity; AV relationship; ectopy; arrhythmia type; heart block]
• Hydrops markers: [Skin edema / ascites / pleural effusion / pericardial effusion / placentomegaly / Doppler compromise signs / absent]

Measurements

(Include only if quantitative data obtained.)

Structure/Parameter	Measurement	Z-score	Notes
[Valve annulus / Doppler velocity / CTR / other]	[Value and units]	[Z-score if available]	[Method/comment]

Impression

• [Primary cardiac diagnosis using standard CHD nomenclature]
• [Associated findings with explicit uncertainty, e.g., "possible restrictive atrial septum," "suspected coarctation—cannot exclude"]
• [Relevant extracardiac diagnoses or concerns]

(For normal studies: "No structural heart disease identified on fetal echocardiogram today." Include residual risk/limitations statement specifying what cannot be fully excluded and why.)

Counseling

[Narrative counseling summary: diagnosis explanation in plain language with anatomic description; natural history and potential in utero evolution; limitations of fetal echocardiography and what cannot be excluded; genetic/extracardiac considerations and whether genetics consultation is recommended (patient preference: accepted / declined / pending); anticipated postnatal physiology (ductal dependence, atrial-level mixing needs, expected saturation targets if discussed); expected postnatal evaluation and interventions (timing of neonatal echo, likely interventions, ICU needs); prognosis discussion. Document patient questions and responses. Note key points patient verbalized to verify understanding.]

(Physiologic implications may be conditional, e.g., "This lesion is typically ductal-dependent for systemic blood flow; plan to initiate prostaglandin after birth unless postnatal echo shows adequate systemic output." If diagnosis uncertain, explicitly document what is uncertain and what additional data are needed.)

Delivery Plan

(Include when CHD or significant cardiac risk exists. For clearly normal fetal echo with no risk factors, state: "No cardiac indication for altered delivery planning; routine obstetric management.")

• Recommended delivery location: [Local birth hospital / tertiary center with required resources (specify: NICU, pediatric cardiology, cath lab, cardiac surgery, ECMO) / To be determined]
• Timing of delivery: [Routine / planned induction / other] | [Cardiac-driven / obstetric-driven]
• Mode of delivery: [Per obstetric indications / specific cardiac constraints if any]
• Delivery room team and immediate steps: [Neonatology presence; cardiology notification timing; respiratory support expectations]
• Immediate postnatal pathway: [ICU / nursery] | [Timing of first postnatal echo]
• Medication plan: [PGE1 anticipated: yes / no / if triggers met] (Define triggers if uncertainty exists.)
• Contingency planning: [Actions if unexpected instability, e.g., urgent atrial septostomy, emergent transfer]

Follow-Up Plan

• Prenatal follow-up: [Repeat fetal echo in X weeks / no further prenatal cardiology follow-up / to be scheduled after pending test]
• Triggers for earlier reassessment: [New hydrops / growth concerns / rhythm changes / abnormal MFM findings]
• Postnatal follow-up: [Outpatient timing for mild/uncertain lesions / inpatient consult for critical lesions; neonatal echo timing]
• Referrals placed: [Genetics / MFM / neonatology / social work / palliative care / none]
• Communication: [Note sent to referrer and OB/MFM; referrer contacted by phone today: yes / no; additional recipients]

Electronically signed by: [Name, credentials] — [Date/time]

(Meta-instructions: For multiple gestations, repeat fetus-specific findings, measurements, impression, counseling, and delivery planning separately for each fetus. Use standardized terms for missing information: Unknown, Not assessed, Denied, Pending, Not in referral records. Do not infer gestational age, genetic results, medication exposures, or findings not directly visualized. Distinguish between "Not visualized" (attempted but limited), "Not assessed" (not attempted), and "Indeterminate" (conflicting signs).)