Fetal medicine: Symptoms, Risk factors and treatment

Fetal Medicine is a specialized branch that deals with the care of the unborn baby while it is still in the mother’s womb. Fetal medicine specialists work in conjunction with obstetricians to provide holistic care for both the mother and the unborn baby.

Fetal medicine is a relatively new specialization and has grown exponentially in its ambit in the recent years. Fetal medicine specialists perform specialized ultrasound scans and procedures in pregnancy, and help guide the care of high risk pregnancies.

The newer concept of pregnancy care is “the inversion of pyramid of care”. Previously, the maximum care provided by doctors in pregnancy used to be in the later half of pregnancy, where most complications of pregnancies occur. Now, with massive improvements in ultrasound, genetics and blood-based screening tests – the maximum care can be provided in the first half of pregnancy itself where risk factors for development of complications can be detected. Once risk factors are identified early, an entire plan of care can be determined, where risk factors can be mitigated, treated or tested. Then, each pregnancy can be provided its optimum level of care based on its individualized risk factors. Fetal medicine specialists play an important role along with obstetricians to determine the risk profile of each pregnancy.

There are screening tests that screen for common chromosomal disorders in each pregnancy. These include the dual marker test, quadruple marker test and Non-Invasive prenatal test. There are also tests available that determine if the mother is at a high-risk for developing high blood pressure in pregnancy – called the preeclampsia screening test. These tests can be provided after the first trimester scan done between 11 to 13 weeks of pregnancy and the obstetrician and fetal medicine specialist can help in selecting the appropriate test for each pregnancy. Once test results are available, further care in terms of additional diagnostic tests like chorionic villus sampling or amniocentesis, or in terms of medication to reduce preeclampsia risk can be planned.

Fetal medicine specialists perform ultrasound scans such as Level 1 scan (between 11 weeks and 13 weeks of pregnancy), Level 2 scan (between 18 and 22 weeks of pregnancy), fetal echocardiography (detailed assessment of the unborn baby’s heart), fetal neurosonography (detailed assessment of the unborn baby’s brain), detailed assessments of the baby’s organ systems, assessment of fetal growth, among others.

Fetal medicine specialists also provide care and monitoring for unborn babies in high risk pregnancies – such as IVF conceptions, mothers with medical disorders diagnosed either before or during pregnancy, mothers with a prior of family history or genetic disorders or bleeding disorders, mothers with a negative blood group and twin or higher order pregnancies. Once any abnormality is diagnosed on ultrasound, fetal medicine specialists can guide regarding possible outcomes, additional testing needed and further plan of care.

Fetal medicine specialists also perform invasive procedures such as chorionic villus sampling, amniocentesis, fetal reductions, fetal blood sampling and fetal blood transfusions. Fetal therapy and treatment for complicated twins that share a common placenta, such as radiofrequency or laser therapy and fetoscopic procedures can also be provided by fetal medicine specialists when needed. Fetal treatments are generally performed to save the unborn babies in the mother’s womb in cases where a lack of treatment will result in loss of life for the unborn babies, or to optimize care and treatment once the babies are delivered.