ARDMS Fetal Echocardiography Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The ARDMS Fetal Echocardiography (FE) exam is a 145-question, 3-hour specialty examination that evaluates your competence in assessing fetal cardiac anatomy, identifying congenital heart defects, and integrating clinical data for comprehensive fetal cardiac evaluation. This guide covers everything you need: exam format, content domains, 10 free practice questions, registration steps, and proven study strategies.
Table of Contents
- What is the Fetal Echocardiography Exam?
- Fetal Echocardiography Exam Format & Structure
- Understanding the 4 Content Domains
- Free Fetal Echocardiography Practice Test Questions
- Fetal Echocardiography Exam Scoring & Pass Rate
- How to Register for the Fetal Echocardiography Exam
- What to Expect on Exam Day
- How Long Should You Study?
- Tips to Pass the Fetal Echocardiography Exam
- FAQs
What is the Fetal Echocardiography Exam?
Why the Fetal Echocardiography is Challenging
The Fetal Echocardiography is often considered one of the more challenging exams because:
- Complex anatomy: The fetal heart is small (often less than 2 cm) and requires precise imaging of multiple structures in motion
- Wide pathology spectrum: You must recognize numerous congenital heart defects, from simple VSDs to complex single ventricle physiology
- Integration skills: The exam heavily tests your ability to correlate findings and understand hemodynamic consequences (31% of content)
- Technical demands: Fetal position, maternal habitus, and gestational age all affect image acquisition
Fetal Echocardiography Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 165 multiple-choice |
| Time Limit | 3 hours (180 minutes) |
| Passing Score | 555 (on a 300-700 scale) |
| Format | Multiple choice and hotspot questions with fetal echocardiographic images |
| Testing Centers | Pearson VUE (in-person or online proctoring) |
| Exam Fee | $300 (as of 2026) |
Understanding the 4 Content Domains
The Fetal Echocardiography exam is divided into 4 content domains, each weighted differently. Knowing these weights helps you prioritize your study time.
Content Domain Weights
Question estimates based on total question count. Focus study time proportionally.
Study tip: Spend the most time on the largest domain—it makes up the biggest portion of your exam.
Domain 1: Assess Anatomy (18%)
Approximately 30 questions
Domain 2: Evaluate Pathology and Pathophysiology (21%)
Approximately 35 questions
Domain 3: Integrate Data (31%)
Approximately 51 questions
Domain 4: Perform the Exam (30%)
Approximately 50 questions
Cardiothoracic ratio: Heart area / Thorax area (normal: ~1/3)
Cardiac axis: Angle of interventricular septum from midline (normal: 45° ± 20° leftward)
Heart rate: Normal fetal range 120-160 bpm
1. Ductus arteriosus: Continuous forward flow throughout cardiac cycle
2. Ductus venosus: A-wave normally above baseline (forward flow)
3. MCA PSV: Used to assess for fetal anemia
4. Tricuspid regurgitation: Velocity >2.5 m/s may indicate elevated RV pressure
5. E/A ratio: Assesses ventricular compliance (E < A in normal fetus)
Free Fetal Echocardiography Practice Test Questions
Test your knowledge with these sample Fetal Echocardiography exam questions. Answers and explanations are provided below.
Question 1
In a normal four-chamber view, what is the expected position of the cardiac apex?
Question 2
Which structure connects the pulmonary artery to the descending aorta in fetal circulation?
Question 3
A fetus at 22 weeks demonstrates a ventricular septal defect with bidirectional shunting. What does this finding suggest?
Question 4
Which view is essential for evaluating the relationship between the great vessels and diagnosing transposition?
Question 5
What is the significance of reversed A-wave in the ductus venosus Doppler waveform?
Question 6
In hypoplastic left heart syndrome (HLHS), which of the following findings would be expected?
Question 7
Which cardiac defect is most commonly associated with increased nuchal translucency in the first trimester?
Question 8
What is the typical appearance of an atrioventricular septal defect (AVSD) in the four-chamber view?
Question 9
During evaluation of the aortic arch, you identify a discrete narrowing distal to the left subclavian artery with turbulent flow. What is the most likely diagnosis?
Question 10
Which finding in the three-vessel trachea view suggests tetralogy of Fallot?
Answer Key with Explanations
The normal fetal cardiac axis shows the apex pointing to the left at approximately 45 degrees (± 20 degrees) from the midline. Deviation from this axis can indicate cardiac malposition or associated anomalies such as congenital diaphragmatic hernia or lung masses.
The ductus arteriosus connects the main pulmonary artery to the descending aorta, allowing most right ventricular output to bypass the lungs. It normally closes shortly after birth. Persistent patency or abnormal Doppler patterns can indicate pathology.
Bidirectional shunting across a VSD is normal in fetal circulation because right and left ventricular pressures are relatively equal. After birth, when pulmonary vascular resistance drops, a VSD typically demonstrates left-to-right shunting.
The three-vessel view (3VV) and three-vessel trachea view (3VT) are essential for evaluating great vessel relationships. In transposition of the great arteries, the normal oblique alignment of the PA and aorta is lost, and the vessels may appear parallel.
Reversed A-wave (flow reversal during atrial contraction) in the ductus venosus suggests elevated right atrial pressure, which may indicate cardiac dysfunction, tricuspid regurgitation, or increased preload. It is associated with adverse outcomes and chromosomal abnormalities.
HLHS is characterized by underdevelopment of left-sided structures including a small or absent left ventricle, mitral atresia or severe stenosis, and aortic atresia or severe stenosis. The ascending aorta is typically hypoplastic, and systemic circulation depends on the ductus arteriosus.
Atrioventricular septal defect (AVSD) is strongly associated with increased nuchal translucency and trisomy 21 (Down syndrome). First-trimester screening findings should prompt detailed fetal echocardiography to evaluate for AVSD and other cardiac anomalies.
Complete AVSD demonstrates absence of the normal crux of the heart, with a common atrioventricular valve spanning both ventricles. An ostium primum atrial septal defect and inlet ventricular septal defect are present. This creates the characteristic 'figure-8' or cloverleaf appearance.
Coarctation of the aorta typically occurs at the aortic isthmus, just distal to the left subclavian artery origin, near the ductus arteriosus insertion. Color Doppler shows turbulent flow at the narrowing. Associated findings include ventricular size discrepancy with right dominance.
Tetralogy of Fallot demonstrates a small pulmonary artery (due to pulmonary stenosis) with an enlarged, overriding aorta. In the 3VT view, the PA appears smaller than normal, and the aorta may show rightward deviation. The four components include VSD, overriding aorta, pulmonary stenosis, and RV hypertrophy.
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Fetal Echocardiography Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Fetal Echocardiography first-time pass rate is approximately 75%. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Subspecialty knowledge: Requires mastery of cardiac embryology and complex congenital heart disease
- Integration emphasis: 31% of the exam focuses on correlating multiple findings to reach conclusions
- Rare pathology: Many defects are uncommon, making clinical exposure challenging
- Hemodynamic understanding: Must understand fetal vs. postnatal circulation differences
Understanding Your Score Report
Your score report includes:
- Overall scaled score (pass/fail)
- Performance breakdown by content domain
- Percentile ranking compared to other examinees
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: 60 days before you can retake
- Maximum attempts: 3 attempts per 12-month period
- Re-application: You must submit a new application and fee for each attempt
How to Register for the Fetal Echocardiography Exam
Step 1: Verify Prerequisites
You must hold a current RDMS or RDCS credential before applying for the Fetal Echocardiography exam.
Step 2: Log into myARDMS
Visit myARDMS.org and log into your existing account to access the examination application.
Step 3: Meet Clinical Requirements
ARDMS requires documented clinical experience in fetal echocardiography:
- Option 1: Complete an accredited fetal echo training program
- Option 2: Document supervised clinical experience performing fetal echocardiograms
- Option 3: Physician pathway with documented fetal echo training
Step 4: Submit Application and Documentation
Select the Fetal Echocardiography examination, upload required clinical documentation, and pay the examination fee ($275 as of 2026).
Step 5: Receive Authorization to Test (ATT)
ARDMS reviews applications within 2-4 weeks. Upon approval, you will receive an ATT via email valid for 90 days.
Step 6: Schedule with Pearson VUE
Use your ATT to schedule at a Pearson VUE testing center or for online proctored testing.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get 7-8 hours of sleep
- Eat a balanced meal - the exam is 3 hours long
- Arrive 30 minutes early
- Bring two forms of valid ID (one with photo and signature)
At the testing center:
- Check in with the test administrator
- Store personal belongings in a locker (no phones, watches, or notes)
- Palm vein scan or photo may be taken for security
During the exam:
- You have 180 minutes for 145 questions (approximately 74 seconds per question)
- Breaks are permitted but count against your time
- Flag difficult questions and return to them if time permits
For Online Proctoring
System requirements:
- Reliable high-speed internet
- Webcam and microphone
- Windows or Mac computer (no tablets)
- Quiet, private room for 3+ hours
Environment requirements:
- Clear desk (remove all items except computer)
- No dual monitors
- Well-lit room where proctor can see you clearly
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Active fetal echo practice with recent training | 6-8 weeks |
| General OB sonographer seeking FE credential | 10-12 weeks |
| Cardiac sonographer new to fetal imaging | 8-10 weeks |
| Limited recent fetal echo exposure | 12-16 weeks |
Sample Study Schedule
Week 1-2: Anatomy Foundation
- Review cardiac embryology and normal development
- Master the four-chamber view and normal anatomy
- Study Domain 1: Assess Anatomy (18%)
- Practice identifying all standard views
Complete 100-150 practice questions
Week 3-4: Outflow Tracts and Great Vessels
- Study LVOT, RVOT, and three-vessel views
- Learn aortic arch and ductal arch anatomy
- Practice recognizing normal vs. abnormal vessel relationships
- Begin Domain 4: Perform the Exam (30%)
Complete 150-200 practice questions
Week 5-6: Pathology Recognition
- Study Domain 2: Evaluate Pathology and Pathophysiology (21%)
- Focus on septal defects (VSD, ASD, AVSD)
- Learn conotruncal anomalies (TOF, TGA, truncus)
- Study left and right heart obstructive lesions
Complete 200+ practice questions
Week 7-8: Data Integration and Hemodynamics
- Study Domain 3: Integrate Data (31%)
- Practice correlating multiple findings
- Understand fetal circulation and shunt physiology
- Learn prognostic indicators and outcome predictors
Complete 200+ practice questions
Week 9-10: Final Preparation
- Take 2-3 full-length timed practice exams
- Review all missed questions thoroughly
- Focus on weak domains identified in practice tests
- Review image optimization and technical factors
- Rest the day before your exam
Tips to Pass the Fetal Echocardiography Exam
1. Master the Four-Chamber View First
The four-chamber view is the foundation of fetal echocardiography. Ensure you can systematically evaluate all structures: atrial and ventricular size, septum, AV valves, pulmonary veins, and cardiac axis. Many defects are detectable in this single view.
2. Learn Systematic Approach to Outflow Tracts
Develop a consistent method for evaluating LVOT and RVOT views. Verify vessel-ventricle connections, assess for stenosis or override, and confirm the great vessels cross normally. This systematic approach helps detect conotruncal anomalies.
3. Understand Fetal Hemodynamics
Fetal circulation differs significantly from postnatal. Understand why VSDs have bidirectional flow in utero, why the ductus arteriosus is essential, and how lesions affect chamber sizes. This knowledge is crucial for the integration domain.
4. Study Associated Anomalies
Many cardiac defects have extracardiac associations. Know the syndromes: AVSD with trisomy 21, conotruncal defects with 22q11 deletion, and left-sided lesions with Turner syndrome. These associations appear frequently on the exam.
5. Practice with Real Case Images
Review fetal echo cases with confirmed diagnoses. Study how different defects appear in various views. The more pathology you visualize, the better your recognition skills will become.
6. Focus on High-Yield Integration Questions
With 31% of the exam testing data integration, practice questions that require combining multiple findings. For example: Right heart dominance + abnormal aortic arch + flow reversal in the isthmus = suspect coarctation.
FAQs
How many questions are on the Fetal Echocardiography exam?
The exam contains approximately 165 multiple-choice questions.
What is the passing score for the Fetal Echo exam?
You need a scaled score of 555 or higher (on a 300-700 scale) to pass.
How long is the Fetal Echocardiography exam?
You have 3 hours (180 minutes) to complete the exam, which is approximately 74 seconds per question.
How much does the Fetal Echo exam cost?
The examination fee is $275 (as of 2026).
What credentials do I need before taking the FE exam?
You must hold a current RDMS or RDCS credential before applying for the Fetal Echocardiography specialty exam.
What is the largest content domain on the FE exam?
Domain 3: Integrate Data accounts for 31% of the exam, making it the largest domain. Domain 4: Perform the Exam is close behind at 30%.
How many times can I take the Fetal Echo exam?
You can attempt the exam up to 3 times within a 12-month period with a mandatory 60-day waiting period between attempts.
Can I take the Fetal Echo exam online?
Yes, ARDMS offers online proctoring through Pearson VUE if you meet the technical and environmental requirements.
What makes fetal echo different from standard OB ultrasound?
Fetal echocardiography is a detailed cardiac evaluation that goes far beyond the four-chamber view obtained in routine OB scanning. It includes multiple specialized views, Doppler assessment of cardiac function, and comprehensive evaluation for congenital heart defects.
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This guide is updated regularly to reflect the latest ARDMS Fetal Echocardiography exam information. Last reviewed: January 2026.