fetal medicine high risk obstance
Fetal Medicine is the study of growth, development, care and treatment of the fetus(unborn child in uterus of a pregnant female). It is also concerned with the study of environmental risks and factors harmful to the fetus.
Importance of fetal medicine:
The advancement in the field of science and technology especially in the field of medicine has made our lives more convenient and has given us an opportunity towards a healthy life.
Fetal medicine is one such outcome of the progress that has provides us in-depth knowledge of the medical, surgical, obstetrical, and genetic complications of pregnancy and their effects on both the mother and fetus. The fetus is now considered as a separate patient since we are now capable of screening and diagnosis of chromosomal problems, structural abnormalities, genetic disorders, fetal infections, diagnosis and treatment of fetal anemia and various other conditions related to the fetus.
Application of Fetal Medicine:
Fetal care involves a multidisciplinary approach with a team comprising of a fetal medicine specialist, fetal cardiologist, paediatric surgeon, paediatric orthopaedician, paediatric neurologist, geneticist, neonatologist and a perinatal pathologist.
The application of featal medicine involves the use of various screening processes, ultrasound scans, genetic studies, fetal blood examinations, fetal echocardiography, and also counselling to the parents of the unborn child.
Fetal medicine aims at early detection of anomalies and various risks revolving around the developing fetus and the mother.
Detection of anomalies:
Viability Scan
It is aimed to check the correct site of pregnancy, the number of fetuses and to check if the pregnancy is progressing normally. This is particularly useful in women who have experienced pain/ bleeding in pregnancy, have history of previous miscarriages or ectopic pregnancy.
Combined First Trimester Screening (11-14 weeks):
This is an ultrasound examination with a blood test. This is the most important scan because it provides an overview of the pregnancy in terms of:
Screening for Down syndrome and chromosomal abnormalities.
Diagnosing major fetal structural abnormalities which can be picked up at this time of pregnancy however a 20 weeks anomaly scan is still essential.
Diagnosing multifetal pregnancies- To decide the management plan depending on whether they share the same placenta (monochorionic) or different placenta (dichorionic) as they have different implications.
To predict adverse pregnancy outcomes in first trimester. – predicting risks for pre eclampsia, fetal growth restriction and preterm delivery so that we can intervene at the correct time.
Anomaly Scan and Risk Reassessment Scan: (18-20 weeks):
This is a detailed scan to look at each fetal system in details and its anatomy. In case any abnormality is detected the significance and management of these findings would be discussed with the couple. Risk Reassessment Scan – To look for soft markers for chromosomal abnormalities in conjunction with Quadruple test for modifying risks for Down syndrome.
Cervical Screening:
This is a transvaginal scan where the mother’s risk of developing preterm labor and preclampsia (High Blood Pressure in Pregnancy) during the pregnancy is assessed and management plan discussed.
Fetal Echocardiography:
A detailed examination of the fetal heart and its connecting vessels is done. It is particularly recommended for those with increased Nuchal Translucency (NT) in first trimester, family history of fetal cardiac defects or previous affected child with cardiac defect & in the presence of other fetal abnormalities. Maternal diabetes mellitus or those women who are on antiepileptic medications are also offered a detailed cardiac scan as they are at increased risk.
Fetal Well Being Scan- (24 to 42 weeks):
To keep a check on fetal growth.
Evaluating the placenta and amniotic fluid.
Evaluating fetal movements.
Ensuring that blood flows to the fetus and placenta are adequate. Special protocols set in certain circumstances – Fetal Growth Restriction/ Twin Pregnancy/ Maternal Complications.
In case of disorders of fetal growth and amniotic fluid volume, further management plan will be discussed.