Fetal Echocardiogram Report

Study Date/Time: [date and time of exam]

Patient: [maternal name, MRN, DOB; fetus identifier if multiple gestation]

Gestational Age: [weeks+days at exam]

EDD: [EDD and dating method]

Ordering Provider: [name, role]

Interpreting Physician: [name, credentials]

Sonographer: [name]

Clinical Information

[Indication for exam; singleton vs multiple gestation with fetus labeling if applicable; relevant clinical context such as known anomalies, genetic findings, or maternal conditions affecting interpretation] (If clinical context is not provided, document only the indication and available dating information.)

Study Details

Study Type: [comprehensive fetal echocardiogram / follow-up / limited]

Technique: [2D imaging / color Doppler / spectral Doppler / M-mode / tissue Doppler / 3D] (List only modalities performed.)

Quality/Completeness: [adequate / suboptimal / limited]; [required components obtained / incomplete] (If incomplete or suboptimal, specify which structures or views were not adequately assessed and why: [fetal position / maternal habitus / early gestational age / acoustic shadowing / fetal motion / other]. If not fully diagnostic, state whether re-imaging is recommended and suggested timeframe.)

Findings

(Use structured statements with accepted congenital heart terminology. Do not state a structure is normal unless adequately assessed. For structures not adequately seen, explicitly state "suboptimally visualized" or "not visualized.")

Fetal Orientation & Situs

• Fetal right/left determination: [established / not established]
• Visceral situs: [situs solitus / situs inversus / situs ambiguous / indeterminate]
• Cardiac position: [levocardia / dextrocardia / mesocardia / indeterminate]
• Cardiac axis: [axis in degrees]

Segmental Cardiac Anatomy

(Document each segment. If a component is not adequately visualized, state so explicitly rather than omitting.)

• Systemic venous connections: [normal / abnormal / suboptimally visualized / not visualized] [details if abnormal including SVC, IVC, ductus venosus pathway findings]
• Pulmonary venous return: [normal / abnormal / suboptimally visualized / not visualized]; [number of veins visualized]; connection to LA: [confirmed / uncertain]; obstruction: [absent / present / uncertain]
• Atria and atrial septum: [normal / abnormal / suboptimally visualized / not visualized]; size balance: [balanced / disproportionate]; foramen ovale: [patent with normal flow / restrictive / aneurysmal / indeterminate]
• AV connections and valves: [normal / abnormal / suboptimally visualized / not visualized]; tricuspid valve: [morphology, regurgitation, stenosis findings]; mitral valve: [morphology, regurgitation, stenosis findings]
• Ventricles and ventricular septum: [normal / abnormal / suboptimally visualized / not visualized]; size balance: [balanced / RV dominant / LV dominant]; function: [normal / mildly decreased / moderately decreased / severely decreased]; VSD: [none seen / suspected / present] at [membranous / muscular / inlet / outlet]; pericardial effusion: [absent / present]
• Ventriculoarterial connections and semilunar valves: [normal / abnormal / suboptimally visualized / not visualized]; great artery relationship: [normal / parallel / transposed / uncertain]; LVOT/aortic valve: [findings]; RVOT/pulmonary valve: [findings]
• Arch anatomy: [normal / abnormal / suboptimally visualized / not visualized]; ductal arch: [patent / constricted / not visualized]; aortic arch laterality: [left / right / indeterminate]; arch: [normal / hypoplastic / interrupted / coarctation suspected]; 3-vessel-trachea view: [normal / abnormal with details]

Rhythm

• Heart rate: [bpm]
• Rhythm: [sinus rhythm / isolated ectopy / supraventricular tachycardia / atrial flutter / complete heart block / other]
• Method: [M-mode / Doppler / both]
• (If abnormal) Atrial rate: [bpm]; ventricular rate: [bpm]; AV relationship: [1:1 / variable / dissociated]

Doppler Summary

(Document only Dopplers performed. Link Doppler evidence to conclusions about stenosis, regurgitation, or hemodynamics.)

• Inflow Dopplers (mitral, tricuspid): [normal / abnormal] [details]
• Outflow Dopplers (aortic, pulmonary): [normal / abnormal]; [peak velocities if measured]
• Arch and ductal flow: [antegrade / retrograde / bidirectional]; [evidence for coarctation or ductal constriction if present]
• Pulmonary venous Doppler: [normal / abnormal] (Include only if performed.)
• Ductus venosus: [normal / abnormal]; A-wave: [forward / absent / reversed]
• Umbilical vessels: UA: [normal / elevated resistance / absent EDF / reversed EDF]; UV: [normal continuous / pulsatile] (Include only if performed.)

Measurements

(Include only if obtained per protocol. Omit entire section if no measurements were obtained.)

• Valve annuli: tricuspid [value, Z-score]; mitral [value, Z-score]; pulmonary [value, Z-score]; aortic [value, Z-score]
• Great vessels: MPA [value, Z-score]; ascending aorta [value, Z-score]; aortic isthmus [value, Z-score]; ductus arteriosus [value, Z-score]
• Functional indices: LV SF [%]; RV SF [%]; MPI [values] (Include only indices obtained.)
• Measurements not obtained: [list with reason] (Include only if expected measurements were unobtainable.)

Extracardiac Findings

(Include only if assessed and clinically relevant to cardiac interpretation. Omit section if not applicable.)

• Hydrops: [absent / present] (If present: ascites [yes/no]; skin edema [yes/no]; pleural effusion [yes/no]; pericardial effusion [yes/no])
• Thoracic masses affecting cardiac position/function: [none / present with details]

Impression

(Numbered summary. Ensure conclusions are consistent with documented findings.)

1. [Primary cardiac diagnosis or "No structural cardiac abnormality identified."]
2. [Key associated physiology if present: dysfunction, significant regurgitation, abnormal Dopplers, hydrops, rhythm disturbance] (Omit if not applicable.)
3. [Diagnostic certainty and differential diagnoses] (Include only when applicable.)
4. [Study limitations with clinical implications; recommendation for re-imaging if needed] (Include only when relevant.)

Recommendations

Prenatal: [Repeat fetal echo timing and purpose / MFM follow-up / pediatric cardiology follow-up / parameters to trend] (For normal low-risk studies: "Routine prenatal care; repeat fetal echo only if clinically indicated.")

Delivery Planning: [Recommended delivery site level with rationale; neonatal team involvement at delivery] (For normal studies: "Routine delivery setting appropriate.")

Postnatal: [Timing of postnatal echo; additional testing if relevant] (For normal low-risk studies: "Postnatal echocardiogram only if clinically indicated.")

Communication

(Include only when critical or time-sensitive findings were communicated. Omit section if no critical communication required.)

• Date/Time: [date and time]
• Recipient: [name, role]
• Method: [phone / secure message / in-person]
• Summary: [content communicated and agreed plan]

Authentication

Interpreting Physician: [printed name, signature, date/time]