NeoCardioLab Normative Z-Score Fetal Echocardiogram App

Important disclaimer: This application is provided by NeoCardioLab solely as an educational and research tool for calculating fetal echocardiographic Z scores from published normative reference equations. It is intended for use by appropriately trained healthcare professionals and does not constitute medical advice, establish a diagnosis, determine prognosis, or provide recommendations regarding fetal surveillance, intervention, delivery planning, or postnatal management. Results depend on the accuracy of the entered data, gestational age estimation, image acquisition, caliper placement, measurement technique, and the applicability of the selected reference population. Z scores may vary among published datasets, ultrasound platforms, operators, and calculation methods, and values outside the reference range do not independently establish disease. All calculations must be independently verified and interpreted within the complete fetal echocardiographic, obstetric, genetic, and clinical context by the responsible treating team. This application must not replace comprehensive image review, serial assessment, specialist consultation, institutional protocols, or professional clinical judgment. NeoCardioLab and the application’s developers make no representation that the tool is error-free or suitable for every fetus or clinical setting and accept no responsibility for clinical decisions, outcomes, losses, or damages arising from its use. Users should not enter names, medical record numbers, dates of birth, or other identifiable patient information into the application. By using this tool, the user acknowledges and accepts these limitations. See Disclaimer - Non-responsabilité section.

References

References are grouped by their application in the NeoCardioLab Fetal Echo Normative Studio. PubMed identifiers were verified on 3 August 2026. “Not indexed in PubMed” means that no PMID exists for that source.

Status key: Unless otherwise marked, a source supplies an executable equation, lookup, or correction used by the app. Reference only identifies contextual datasets retained in the Reference atlas but not used for computation. Guideline/context identifies practice guidance that supplies no normative equation.

1. Fetal cardiac structure and geometry calculators

Schneider C, McCrindle BW, Carvalho JS, Hornberger LK, McCarthy KP, Daubeney PE. Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol. 2005;26(6):599-605. doi:10.1002/uog.2597. PMID: 16254878.
Pasquini L, Mellander M, Seale A, Matsui H, Roughton M, Ho SY, et al. Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol. 2007;29(6):628-633. doi:10.1002/uog.4021. PMID: 17476706.
Lee W, Riggs T, Amula V, Tsimis M, Cutler N, Bronsteen R, et al. Fetal echocardiography: z-score reference ranges for a large patient population. Ultrasound Obstet Gynecol. 2010;35(1):28-34. doi:10.1002/uog.7483. PMID: 20014329.
Gabbay-Benziv R, Turan OM, Harman C, Turan S. Nomograms for fetal cardiac ventricular width and right-to-left ventricular ratio. J Ultrasound Med. 2015;34(11):2049-2055. doi:10.7863/ultra.14.10022. PMID: 26446818.
Krishnan A, Pike JI, McCarter R, Fulgium AL, Wilson E, Donofrio MT, et al. Predictive models for normal fetal cardiac structures. J Am Soc Echocardiogr. 2016;29(12):1197-1206. doi:10.1016/j.echo.2016.08.019. PMID: 27773520.
Vigneswaran TV, Akolekar R, Syngelaki A, Charakida M, Allan LD, Nicolaides KH, et al. Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases. Circ Cardiovasc Imaging. 2018;11(7):e007575. doi:10.1161/CIRCIMAGING.118.007575. PMID: 30006353.
García-Otero L, Gómez O, Rodriguez-López M, Torres X, Soveral I, Sepúlveda-Martínez Á, et al. Nomograms of fetal cardiac dimensions at 18-41 weeks of gestation. Fetal Diagn Ther. 2020;47(5):387-398. doi:10.1159/000494838. PMID: 30612128.
García-Otero L, Soveral I, Sepúlveda-Martínez Á, Rodriguez-López M, Torres X, Guirado L, et al. Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks. Ultrasound Obstet Gynecol. 2021;58(3):388-397. doi:10.1002/uog.23127. PMID: 32959925.
Lussier EC, Yeh SJ, Chih WL, Lin SM, Chou YC, Huang SP, et al. Reference ranges and Z-scores for fetal cardiac measurements from two-dimensional echocardiography in Asian population. PLoS One. 2020;15(6):e0233179. doi:10.1371/journal.pone.0233179. PMID: 32584813.
Sompagdee N, Anuwutnavin S, Burapasikarin C, Ruangvutilert P, Thongkloung P. Nomograms of fetal cardiothoracic ratio from 17 to 37 weeks' gestation as assessed by three different measurement techniques and their correlation with gestational age. Prenat Diagn. 2021;41(13):1658-1667. doi:10.1002/pd.6057. PMID: 34647342.

2. Disease-specific left-heart and aortic-arch support

McElhinney DB, Marshall AC, Wilkins-Haug LE, Brown DW, Benson CB, Silva V, et al. Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation. 2009;120(15):1482-1490. doi:10.1161/CIRCULATIONAHA.109.848994. PMID: 19786635.
Reference only — not used for computation. Quartermain MD, Cohen MS, Dominguez TE, Tian Z, Donaghue DD, Rychik J. Left ventricle to right ventricle size discrepancy in the fetus: the presence of critical congenital heart disease can be reliably predicted. J Am Soc Echocardiogr. 2009;22(11):1296-1301. doi:10.1016/j.echo.2009.08.008. PMID: 19815386.

3. Combined structural and pulsed-wave Doppler reference atlas (reference only)

Reference only — not used for computation. Peng N, Weng Z, Xie J, Wang H, Li X, Ji X, et al. Reference ranges and Z-score calculators for pulsed-wave Doppler and structural measurements in fetal echocardiography between 18 and 35 weeks of gestation: a cross-sectional study. J Ultrasound Med. 2026;45(3):547-555. doi:10.1002/jum.70089. PMID: 41108647. The required supplemental coefficient tables were not available in the supplied article, so the app does not fabricate or execute Peng models.

4. Pulsed-wave Doppler, M-mode, ductal and venous flow

Gagnon C, Bigras JL, Fouron JC, Dallaire F. Reference values and Z scores for pulsed-wave Doppler and M-mode measurements in fetal echocardiography. J Am Soc Echocardiogr. 2016;29(5):448-460.e9. doi:10.1016/j.echo.2016.01.002. PMID: 26971082.
Correction. J Am Soc Echocardiogr. 2019;32(1):169-170. doi:10.1016/j.echo.2018.10.015. PMID: 30611377. This erratum controls conflicts with the original Gagnon tables.
Zidere V, Vigneswaran TV, Syngelaki A, Charakida M, Allan LD, Nicolaides KH, et al. Reference ranges for pulsed-wave Doppler of the fetal cardiac inflow and outflow tracts from 13 to 36 weeks' gestation. J Am Soc Echocardiogr. 2021;34(9):1007-1016.e10. doi:10.1016/j.echo.2021.04.017. PMID: 33957251.
Tulzer G, Gudmundsson S, Sharkey AM, Wood DC, Cohen AW, Huhta JC. Doppler echocardiography of fetal ductus arteriosus constriction versus increased right ventricular output. J Am Coll Cardiol. 1991;18(2):532-536. doi:10.1016/0735-1097(91)90611-C. PMID: 1856423. App location: Cardiac calculator → Rhythm → Ductal PI.

Reference only — not used for computation. Stefopoulou M, Herling L, Johnson J, Lindgren P, Kiserud T, Acharya G. Reference ranges of fetal superior vena cava blood flow velocities and pulsatility index in the second half of pregnancy: a longitudinal study. BMC Pregnancy Childbirth. 2021;21(1):158. doi:10.1186/s12884-021-03635-6. PMID: 33622280.
Reference only — not used for computation. Parasuraman R, Osmond C, Howe DT. Gestation-specific reference intervals for fetal cardiac Doppler indices from 12 to 40 weeks of gestation. Open J Obstet Gynecol. 2013;3(1):97-104. doi:10.4236/ojog.2013.31019. PMID: not indexed in PubMed.

5. Myocardial tissue Doppler

Comas M, Crispi F, Gómez O, Puerto B, Figueras F, Gratacós E. Gestational age- and estimated fetal weight-adjusted reference ranges for myocardial tissue Doppler indices at 24-41 weeks' gestation. Ultrasound Obstet Gynecol. 2011;37(1):57-64. doi:10.1002/uog.8870. PMID: 21046540.
Reference only — not used for computation. Chan LY, Fok WY, Wong JT, Yu CM, Leung TN, Lau TK. Reference charts of gestation-specific tissue Doppler imaging indices of systolic and diastolic functions in the normal fetal heart. Am Heart J. 2005;150(4):750-755. doi:10.1016/j.ahj.2004.12.028. PMID: 16209978.
Reference only — not used for computation. Harada K, Tsuda A, Orino T, Tanaka T, Takada G. Tissue Doppler imaging in the normal fetus. Int J Cardiol. 1999;71(3):227-234. doi:10.1016/S0167-5273(99)00152-7. PMID: 10636528.

6. Fetal cardiac output

Luewan S, Srisupundit K, Tongprasert F, Traisrisilp K, Jatavan P, Tongsong T. Z score reference ranges of fetal cardiac output from 12 to 40 weeks of pregnancy. J Ultrasound Med. 2020;39(3):515-527. doi:10.1002/jum.15128. PMID: 31512764.
Reference only — not used for computation. Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation. 2001;103(12):1662-1668. doi:10.1161/01.CIR.103.12.1662. PMID: 11273994.

7. Rhythm, atrioventricular and ventriculoatrial intervals

Cuneo BF, Bitant S, Strasburger JF, Kaizer AM, Wakai RT. Assessment of atrioventricular conduction by echocardiography and magnetocardiography in normal and anti-Ro/SSA-antibody-positive pregnancies. Ultrasound Obstet Gynecol. 2019;54(5):625-633. doi:10.1002/uog.20245. PMID: 30784137.
Amorim LADR, Bravo-Valenzuela NJ, Almeida SLM, Peixoto AB, Nicoloso LHS, Schmidt MM, et al. Development of a Z-score equation for atrioventricular interval measurement by two-dimensional pulsed Doppler echocardiography in normal fetuses between 16 and 33+6 weeks of gestation. Ultrasonography. 2025;44(3):212-219. doi:10.14366/usg.24142. PMID: 40360248.
Reference only — not used for computation. Heetchuay T, Trakulmungkichkarn T, Pabalan N, Imsom-Somboon N. Reference values of fetal atrioventricular time intervals derive from antegrade late diastolic arterial blood flow (ALDAF) from 14 to 40 weeks of gestation. Clin Exp Obstet Gynecol. 2021;48(4):867-874. doi:10.31083/j.ceog4804137. PMID: not indexed in PubMed.

Reference only — not used for computation. Thirawat S, Sudjai D. Normal reference values of fetal atrioventricular (AV) and ventriculoatrial (VA) time intervals and VA:AV ratio assessed by pulse wave Doppler. J Med Assoc Thai. 2021;104(5):781-786. doi:10.35755/jmedassocthai.2021.05.12105. PMID: not indexed in PubMed.

8. WHO fetal-growth module

Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14(1):e1002220. doi:10.1371/journal.pmed.1002220. PMID: 28118360.
Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. Correction: The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14(3):e1002284. doi:10.1371/journal.pmed.1002284. PMID: 28339475.
Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Jensen LN, et al. Correction: The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2021;18(1):e1003526. doi:10.1371/journal.pmed.1003526. PMID: 33411728.

9. Biometry dating and estimated fetal weight

Altman DG, Chitty LS. New charts for ultrasound dating of pregnancy. Ultrasound Obstet Gynecol. 1997;10(3):174-191. doi:10.1046/j.1469-0705.1997.10030174.x. PMID: 9339525.
Shepard MJ, Richards VA, Berkowitz RL, Warsof SL, Hobbins JC. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol. 1982;142(1):47-54. doi:10.1016/S0002-9378(16)32283-9. PMID: 7055171.
Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK. Sonographic estimation of fetal weight: the value of femur length in addition to head and abdomen measurements. Radiology. 1984;150(2):535-540. doi:10.1148/radiology.150.2.6691115. PMID: 6691115.
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements: a prospective study. Am J Obstet Gynecol. 1985;151(3):333-337. doi:10.1016/0002-9378(85)90298-4. PMID: 3881966.

10. Clinical guidance, acquisition and safety context

Guideline/context — not used for computation. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Fetal Echocardiography. J Ultrasound Med. 2020;39(1):E5-E16. doi:10.1002/jum.15188. PMID: 31846540.
Guideline/context — not used for computation. Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129(21):2183-2242. doi:10.1161/01.CIR.0000437597.44550.5d. PMID: 24763516.

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