FETAL MEDICINE

ABOUT FETAL MEDICINE

Fetal medicine can be defined as the new age medical intervention science that helps in detecting birth defects in the fetus. This field of science detects most abnormalities in the baby before it is born. Fetal medicine also supports in the prenatal management and the diagnosis of the defects through surgery, delivery and post birth care (multidisciplinary team approach). This empowers the expecting parents and the doctors of what lies ahead. Based on the detection, the parents have the choice of managing most fetal defects intrauterine. This procedure is also useful for saving their child from any abnormalities.

This procedure is also useful for saving their child from any abnormalities. Motherland Hospital has a special unit that provides a well-formulated multidisciplinary approach to treat and detect fetal abnormalities. The department of Fetal Medicine also helps in planning the pregnancy of the complicated cases along with obstetricians, neonatologists, pediatric surgeons and cardiologists.

Fetal medicine also includes multi-disciplinary approach and support of various other departments to deliver the best care that is needed.

At Motherland Hospital, Fetal Medicine is further divide into two specializations.

1. Prenatal Diagnosis

2. Fetal Treatment

Prenatal diagnosis is the ever-improving ability to detect abnormal conditions of the fetus (and to differentiate them from normal fetal development). The most common (and often first) test used for prenatal diagnosis is ultrasound.
SCREENING TESTS IN FETAL MEDICINE


Due to the advancements in medicine, we now have several methods used to screen and detect the abnormalities that may be present in the fetus. The special techniques help parents to be aware and manage pregnancies especially when they have a history of life altering genetic diseases. The science also provides options to rectify certain defects in the womb itself, providing the parents do not blindly opt for medical termination.

Common diseases for which fetal medicine look out are – Down’s syndrome, other chromosomal abnormalities like Edwards, patau syndrome, Di George syndrome and structural defects like Open Spina Bifida, limb abnormalities, skeletal abnormalities, bladder obstruction etc.


The various options for screening and detection are:

Ultrasound – This is the simplest and the most common detection technique. This helps to pick up most structural abnormalities and gives a clue for the underlying chromosomal abnormality.

An important marker of the chromosomal abnormality especially Down syndrome is NUCHAL TRANSLUCENCY which with the advancement has been combined with the other markers like NASAL BONE< DUCTUS VENOSUS AND TRICUPID REGURGITATION , to know the risks of you having a Down syndrome baby (e.g. 1in 50, 1in 10000).

Adding certain blood tests improves the level of accuracy of the diagnosis of Down syndrome. Depending on the Gestation weeks , they are referred to as DUAL “quadruple” tests. Triple test is obsolete now a days as its efficiency is not that much.

Invasive diagnostic tests – They require a form of surgical intervention in the form of insertion of a fine needle into the uterus under ultrasound guidance. The most common invasive tests are: Amniocentesis, Chorion villus sampling, and fetal blood sampling.

In rare cases, fetal MRI is also used as a modality to diagnose defect especially for the fetal brain.

NIPT /NIFTY is a novel SCREENING test with a very high accuracy(99.6%) for Down syndrome without any risk of miscarriage , as it is done by segregating fetal DNA from mother’s blood by an advance technique.


INTERVENTIONS

Motherland Hospital has a well developed and managed Fetal Medicine unit that is proficient to perform a number of fetal medicine management interventions to ensure that the baby gets right treatment and is delivered healthy.

Intrauterine transfusion – It can be defined as a procedure in which red blood cells from a donor are injected into the umbilical cord (usually) of the fetus. This procedure is required when the fetus is suffering from anemia, which may be caused due to an Rh iso immunized pregnancy (Rh negative mothers and Rh positive fetus with a feto maternal exchange) or Pavo virus B 19 infection in the mother.

Fetoscopic laser photocoagulation of TTSS – This is a procedure that is seen 10-15% of the pregnancies with identical twins that end up sharing one placenta. In this case, there are abnormally connected blood vessels connecting the two twins, leading to an unequal sharing. One twin ends up supplying blood to the other, due to which there is excess of blood in one twin leading to more urine, enlarged bladder and subsequent heart failure.

TTTS is often found in second trimester routine ultrasound scans. Fetoscopic laser photocoagulation is a minimally invasive surgical procedure used to treat most cases (depending upon the severity/staging) of TTTS. It uses a small camera (fetoscope) to locate abnormal blood vessel connections in the placenta and Seal them using laser energy.

Radio frequency ablation/Cord coagulation for single twin anomaly – A highly selective fetal intervention concerned for the coexisting twin’s health or life, blood flow to the affected twin is interrupted using radio frequency waves or bipolar energy. A clinical example of this procedure being used is a TRAP sequence, where the life of the pump twin is in imminent danger or a discordant anomalous twin pregnancy (one twin anomalous).

Fetal shunt placement- An ultrasound-guided fetal intervention where a tube (shunt) is placed in the bladder to and other end in the amniotic cavity, leading to drainage of the blocked urine.

Amniotic band resection – Amniotic bands that are constricting the umbilical cord or the extremities and threaten amputation may be divided. With a combination of ultrasound guidance and fetoscopy (a tube with a camera at the tip inserted into the uterus), the bands can be identified and divided with surgical instruments or laser.

Selective Embryo Reduction – In case of higher order multiple pregnancy, it is advisable to reduce the number of fetuses to two in order to minimize risks of multiple pregnancy both to the mother as well to the fetuses.


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