Echogenic intracardiac focus

By trimester

Weeks 1–13

1st trimester

An echogenic intracardiac focus is generally discussed after a second-trimester anatomy scan, not as a first-trimester finding. First-trimester decisions instead center on whether aneuploidy screening was completed and what those results showed. Keep the planned anatomy scan even after a low-risk screening result.

Weeks 14–27

2nd trimester

At the anatomy scan, confirm whether the echogenic intracardiac focus is truly isolated after a detailed survey. If prior serum or cell-free DNA screening was negative, current guidance recommends no additional assessment for the focus. Without prior screening, discuss cell-free DNA or quad screening rather than interpreting the spot alone.

Weeks 28–birth

3rd trimester

An isolated echogenic intracardiac focus with negative screening does not need a third-trimester scan, fetal echocardiogram, or newborn assessment solely because of the focus. Follow-up changes if another anomaly, growth concern, or additional soft marker is present, because the finding is then no longer isolated.

What does the evidence show for echogenic intracardiac focus?

• SMFM defines an isolated soft marker as one found without a structural anomaly, growth restriction, or another marker after a detailed ultrasound. With negative serum or cell-free DNA screening, an isolated echogenic intracardiac focus is a normal variant with no indication for fetal echocardiography, follow-up ultrasound, or postnatal assessment solely for that finding. 1
• In a retrospective cohort of 391 pregnancies with an isolated echogenic intracardiac focus, none of the 348 pregnancies with low-risk triple-screen results had trisomy 21, while one case occurred among 43 with a high-risk screen. This older serum-screening cohort supports interpreting the focus together with prior screening, not alone. 2
• A blinded review of 200 routine 18-to-22-week scans found true echogenic intracardiac foci in 5.5% but false bright reflections in 17%. This small imaging study shows that angle-dependent artifacts can mimic a focus and that image review matters when the finding is uncertain. 3
• A prospective comparison of 138 fetuses with an echogenic intracardiac focus and 167 without one found nearly identical frequencies of structural cardiac abnormalities on detailed fetal echocardiography, with no statistically significant difference. The study was too small to establish equivalence but did not support EIF as a structural heart defect. 4
• A systematic review of 19 cohort studies found most echogenic intracardiac foci were left-sided and found no evidence that EIF alone was highly predictive of chromosomal abnormality or preterm birth. A possible association between persistent right-sided foci and cardiac abnormality was based on rare cases and limited-quality evidence. 5

When should I call my provider about echogenic intracardiac focus?

An isolated echogenic intracardiac focus does not cause maternal symptoms and is not itself an emergency. Promptly contact the obstetric team if the report also lists a structural anomaly, growth restriction, another soft marker, or an incomplete anatomy survey, because the isolated-finding guidance may not apply. Seek urgent obstetric care for pregnancy warning signs such as heavy bleeding, fluid leakage, severe pain, or reduced fetal movement. When in doubt, call your obstetric team the same day. Early input almost always beats waiting, and the on-call line exists exactly for this.