Fetal Cardiology Services at Leeds Teaching Hospitals NHS
Trust
Currently the Fetal Cardiology department at Leeds Teaching Hospitals NHS Trust comprises:

Fetal Cardiology Consultant (Lead for service 4.5 sessions per week),

2nd Fetal Cardiology Consultant (1 session per week)

Team of Sonographers- including a Consultant Sonographer further highly specialised Sonographers
and those in training

3 Cardiac Liaison nurses sharing the role

Paediatric Cardiothoracic Surgeon

Clerical support
The Department is recognised for subspeciality training in Fetal Cardiology and currently has a nationally
appointed final year trainee.
We currently receive referrals from GP, Midwives, DGH Obstetrics as Tertiary Fetal medicine Units
(Leeds and Sheffield) to Consultant led clinics.
After being seen in the Fetal Cardiology clinic the patients are managed in the following way
1. Normal Fetal Cardiology review- referred back to DGH Obstetrics/midwife/GP for normal pregnancy
management.
2. Abnormal Fetal Cardiology review (not structural abnormality) e.g. Fetal ectopic beats- referred back
to DGH Obstetrics/midwife/GP surveillance/management of specific problem.
3. Abnormal Fetal Cardiology review (structural abnormality) – referred to Fetal Medicine
(Leeds/Sheffield) for further investigation and management. Also can be referred back to DGH
Obstetrics.
When severe CHD is diagnosed in the fetus, one or more further appointments are made in Fetal
Cardiology clinic to assess the progression of the abnormality and also to plan delivery. The option is
given to the patient to meet with a Cardiothoracic surgeon.
Delivery of Fetuses with Congenital heart disease after antenatal diagnosis made
The aim is to deliver babies in Leeds where it is felt that outcome would be improved from urgent
Paediatric Cardiology assessment.
Decision should be made on a case by case basis
New Developments within Leeds Fetal Service
Role of the Liaison Nurse
As part of appointment of Paediatric Cardiologist with clinical lead for Fetal Cardiology the role of the
Cardiac Liaison nurse has been developed further.
With increased activity, the Fetal clinics have now increased in frequency.
Role of the nurse in clinic

Support the Consultant in providing relevant information related to the cardiac diagnosis, and written
information to support this

Provide the patient and family with information regarding support groups, contact details of the Nurse
Specialist service for follow-up support

Counsels and supports families following a Fetal diagnosis
Role of the nurse between clinics

Be available as point of contact for families

Provide patients with follow-up telephone call to support the family following diagnosis and answer
any further questions
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Prepare the family for admission to the cardiac ward or neonatal unit
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Liaise with obstetric units/midwifery departments, to encourage two-way communication and assist
families in decision making re. continuing with pregnancy

Information for families re TOP/Feticide if necessary and post TOP support groups
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Post TOP/IUD/Delivery counselling
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Be part of Surgical/Fetal clinic
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Liaise with local Paeds or NNU/Neonatologists re impending deliveries
Development of role to assist in developing the service

To assist in data collection to provide up to date information re. the progress of the pregnancy, to
enable the team to plan services

To assist in developing a Fetal Cardiac Network within obstetric services in the District General
Hospitals

Teaching programme for midwives re. congenital heart disease

Follow up and outcome data once delivered
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Produce written information leaflets tailor made to Fetal Cardiology Service
Cardiac Surgical Fetal Clinic
Have developed joint service with Congenital Cardiothoracic Surgeon. Opportunity for families with a
fetus diagnosed with CHD to discuss surgical options prior to delivery. Once baby delivered parents may
be on different sites. Opportunity to anticipate and plan management. Anticipated deliveries discussed in
Departmental MDT to anticipate workload within busy department
Improving the antenatal detection rate of CHD
An extensive education programme for Sonographers was carried out by Consultant Fetal Cardiologist and
Consultant Sonographer throughout the Yorks and Humber region in 2011. This was funded and supported
by The Fetal Anomaly Screening Programme (FASP). 4 half day sessions were delivered providing the
background and theoretical knowledge behind Fetal Cardiac scanning and then practical sessions were
delivered in all the hospitals within the region taking up the training. 241 staff were identified in the
Yorkshire and Humber region undertaking Fetal Cardiac scanning as part of their day to day practice. 227
of them (94%) attended the half day theory session and 233 (96.7%) accessed and 201 (83.8%) completed
a modified online Fetal Cardiac training module produced by FASP. 209 (86.7%) of sonographers attended
a practical session although the numbers did increase with a mop up session later in the year. The overall
evaluation for the online resource, lecture based sessions and hands on practical training was a mean of
4.6/5.
Implication for Fetal cardiology service
Suspicion of Congenital heart disease by Sonographers will increase the numbers of patients with a
definitive diagnosis made antenatally.
There is clear evidence of benefit of antenatally diagnosed transposition of the great arteries with
statistically significant improvement in preoperative and postoperative morbidity and mortality. (Bonnet et
al 1999) The literature also supports benefits of antenatal diagnosis in hypoplastic left heart syndrome;
improved hospital survival, less significant metabolic acidosis and fewer adverse perioperative
neurological events within 6 wks of surgery. (Chang 1991, Tworetsky 2001, Mahle 2001). Benefits have
also been shown more generally with antenatal diagnosis of congenital heart disease showing significant
prevention of abnormalities of acid-base balance (Verheijen 2001)
Aside from clinical issues, there are significant benefits for the families, to understand and anticipate
diagnosis, allow for counselling and the opportunity to meet surgeons and discuss surgery. There is a
documented improvement of psychological impact on the parents when congenital heart disease is
diagnosed antenatally. (Sklanksy 2002)
There is also benefit to the Paediatric Cardiology department; to be able to plan for expected deliveries,
anticipate workload and imminent surgery, improved transition Obstetrics-Neonates-Paed Cardiology,
improved handover.