Management of Echogenic Intracardiac Focus (EIF) in Pregnancy
An isolated echogenic intracardiac focus is a normal variant that requires no intervention to "decrease risks" because it poses no risk to the pregnancy when aneuploidy screening is negative. 1, 2
Understanding What EIF Actually Represents
EIF is not a pregnancy complication—it is a benign finding that represents microcalcification of the papillary muscles in the fetal heart. 1, 3 This is a critical distinction that fundamentally changes how we approach this finding:
- EIFs occur in 3-5% of chromosomally normal fetuses and represent normal anatomic variation 1, 2
- They are not structural cardiac abnormalities and carry no association with congenital heart disease in the newborn 1, 3
- The finding has significant ethnic variation, occurring in up to 8.1% of Middle Eastern women and 6.9% of Asian American women 1, 2
Risk Assessment Based on Prior Screening Status
If You Have Already Had Negative Aneuploidy Screening
No action is needed whatsoever. 1, 2, 3 The Society for Maternal-Fetal Medicine explicitly states:
- No further aneuploidy evaluation is indicated 1
- No fetal echocardiography is needed 1, 3
- No follow-up ultrasound is required 1
- No postnatal cardiac evaluation is necessary 1
- The finding should be treated as a normal variant of no clinical importance 1, 2
This recommendation applies whether your prior screening was first-trimester combined screening, cell-free DNA testing, or quad screen. 1
If You Have Not Had Any Aneuploidy Screening
The only "risk" associated with isolated EIF is a minimal increase in the likelihood of trisomy 21 (Down syndrome), with a positive likelihood ratio of only 1.4-1.8. 1, 2 A 2013 meta-analysis actually showed no association at all (likelihood ratio 0.95). 1, 2
In this scenario, you should:
- Undergo counseling about the probability of trisomy 21 1
- Consider noninvasive screening with cell-free DNA testing (preferred) or quad screen if cell-free DNA is unavailable or cost-prohibitive 1, 2
- Avoid amniocentesis solely based on the EIF finding, as diagnostic testing is not recommended for this indication alone 1, 2, 3
What About Cardiac Risk?
Left-sided EIF (which accounts for 87-93% of all EIF cases) carries no cardiac risk and requires no cardiac follow-up. 3, 4, 5 However, there are two specific scenarios where cardiac considerations apply:
- Right-sided EIF that persists into the third trimester may warrant additional cardiac evaluation, as this rare finding (occurring in approximately 4 per 10,000 pregnancies) has been associated with minor cardiac abnormalities like ventricular septal defects 6, 4
- If EIF persists beyond 28 weeks gestation, some evidence suggests a higher rate of pathogenic copy number variations (20% vs. 2.2% before 28 weeks), though this is based on limited data 6
For the typical left-sided EIF identified at the 18-20 week anatomy scan, no cardiac follow-up of any kind is needed. 1, 3
Common Pitfalls to Avoid
- Do not order fetal echocardiography for isolated left-sided EIF—this increases healthcare costs without providing benefit 1, 3
- Do not pursue amniocentesis based solely on EIF, especially after negative screening 1, 3
- Do not schedule follow-up ultrasounds to "watch" the EIF—it may or may not resolve, and this has no clinical significance 1
- Do not arrange postnatal cardiac evaluation for isolated EIF 1
The Bottom Line
There are no "risks to decrease" with an isolated EIF because it is not a pathologic finding. 1, 2 If you have had negative aneuploidy screening (cell-free DNA, first-trimester screen, or quad screen), the EIF should be completely disregarded as it has zero clinical implications for your pregnancy or your baby's health. 1, 2, 3 If you have not had screening, the only consideration is whether to pursue noninvasive aneuploidy screening to assess for trisomy 21, recognizing that the association between isolated EIF and Down syndrome is minimal at best. 1, 2, 7