How to facilitate ultrasound examination of the fetal heart: the 5-4-3-2-1 method.

Abstract

We propose a new standardized, systematic method of fetal cardiac screening, the step-by-step '5-4-3-2-1' method. This method is based on understanding the cardiac structures through a process of navigating between the different recommended views during an abdominothoracic sweep, following a user-friendly checklist to identify the main ultrasound features associated with congenital heart defects (CHD). The components (or 'points') that form the checklist in each of the views have been selected in order to cover most CHD, with particular focus on abnormalities associated with genetic disorders and critical CHD. This easy-to-remember 5-4-3-2-1 method provides an overview of the fetal heart at the start of the abdominothoracic sweep by checking 5 points, then assesses the four-chamber view checking 4 points, the three-vessel and three-vessel-and-trachea views checking 3 points and the two outflow tracts checking 2 points, and then uses color Doppler to check 1 final point. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.