Fetal Medicine

Fetal medicine includes the assessment of fetal growth and wellbeing, the maintenance of fetal health, the diagnosis of fetal illnesses and abnormalities and treatment of the “unborn patient”. Our capability to diagnose problems before birth has improved through state-of-the-art prenatal diagnosis techniques giving patients better chance of wellbeing. Our ultrasound scans are performed to the highest standards and are backed up with informative and sensitive counseling by maternal-foetal medicine specialists and geneticists. Foetal medicine team includes obstetricians, perinatologists (also called maternal-foetal medicine specialists), neonatologists, pediatric cardiologists, pediatric surgical specialists, geneticists and others.

Our services are as follows:

A nuchal translucency screening, or NT screening, is a routine ultrasound performed between week 11 and week 13 of pregnancy. Fetuses with increased fluid at the base of their necks may have a chromosomal problem such as Down syndrome.

 

Nuchal Translucency Scan is a Prenatal Screening, which means the results can't tell you for sure whether your child has a chromosomal disorder, only the statistical likelihood. It's often combined with a blood test to offer more insight into the relative odds of your baby being born with a genetic disorder.

When a nuchal translucency screening is done

NT screening must be performed between 11 and 13 weeks of pregnancy. After that, the tissue gets so thick that it's no longer translucent, making test results inconclusive.

What does nuchal translucency measure?

NT focuses on a small, clear space at the back of a growing baby's neck called the nuchal fold. Experts have found that this spot tends to accumulate fluid and, as a result, expands in size in babies who have genetic abnormalities like Down syndrome (caused by an extra copy of chromosome 21, one of the 23 pairs of chromosomes that contain a person's genetic code), trisomy 18 (an extra copy of chromosome 18) and trisomy 13 (an extra number 13 chromosome).

The growth scan, which is sometimes called the wellbeing scan or positioning scan, takes place when you are between 23 and 40 weeks pregnant. It checks how well your baby is growing and their position in the uterus (womb).

During the scan we:

  • measure the baby's head, abdomen and thigh bone
  • assess the amount of amniotic fluid around the baby
  • observe the baby's activity
  • measure the blood flow in the umbilical cord using Doppler ultrasound
  • record the position of the placenta.

The measurements of the head, tummy and leg allow us to estimate fetal weight. We plot all the measurements on a chart against the normal range and this enables us to assess the fetal growth. Your baby is likely to be an average size if the measurements are all within normal limits. If concerns arise from the results of this scan, you will have the opportunity to discuss their implications with our consultant obstetrician.

The baby's position usually becomes stable from 34 weeks onwards. Hence we can perform a scan to determine the position at this stage. If the scan reveals a breech position we can then discuss options open to you such as external cephalic version (ECV) or caesarean section. ECV is the act of turning the baby by hand. Your baby is breech when their bottom, foot or feet, instead of their head, leads the way out of the uterus.

Consult your gynaecologist:

  • prior to any ultrasound examination for discussion
  • if you have any doubts of the necessity of any scan
  • if you have concerns of your baby's well-being at any stage of your pregnancy.

Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, say quadruplets, to a twin or singleton pregnancy. The procedure is also called multifetal pregnancy reduction. The procedure is most commonly done to reduce the number of fetuses in a multiple pregnancy to a safe number, when the multiple pregnancy is the result of use of assisted reproductive technology; outcomes for both the mother and the babies are generally worse, the higher the number of fetuses.The procedure is also used in multiple pregnancies when one of the fetuses has a serious and incurable disease, or in the case where one of the fetuses is outside the uterus, in which case it is called selective termination.

 

The procedure generally takes two days; the first day for testing in order to select which fetuses to reduce, and the second day for the procedure itself, in which potassium chloride is injected into the heart of each selected fetus under the guidance of ultrasound imaging. Risks of the procedure include bleeding requiring transfusion, rupture of the uterus, retained placenta, infection, a miscarriage, and prelabor rupture of membranes. Each of these appears to be rare.

 

Source : Wikipedia

Fetoscopy is an endoscopic procedure during pregnancy to allow surgical access to the fetus, the amniotic cavity, the umbilical cord, and the fetal side of the placenta. A small (3–4 mm) incision is made in the abdomen, and an endoscope is inserted through the abdominal wall and uterus into the amniotic cavity. Fetoscopy allows for medical interventions such as a biopsy (tissue sample) or a laser occlusion of abnormal blood vessels (such as chorioangioma) or the treatment of spina bifida.<br>

Fetoscopy is usually performed in the second or third trimester of pregnancy. The procedure can place the fetus at increased risk of adverse outcomes, including fetal loss or preterm delivery, so the risks and benefits must be carefully weighed in order to protect the health of the mother and fetus(es). The procedure is typically performed in an operating room by an obstetrician-gynecologist.

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Intrauterine Blood Transfusion

An Intrauterine transfusion (IUT) is a procedure that provides blood to a fetus, most commonly through the umbilical cord. It is used in cases of severe fetal anemia, such as when fetal red blood cells are being destroyed by maternal antibodies

Source: Wikipedia

The anomaly scan, also sometimes called the anatomy scan20 week ultrasound, or level 2 ultrasound, evaluates anatomic structures of the fetus, placenta, and maternal pelvic organs. This scan is an important component of routine prenatal care.

This scan is conducted between 18 to 22 weeks gestation as a component of routine prenatal care. Prior to 18 weeks gestation, the fetal organs may be of insufficient size and development to allow for ultrasound evaluation. Scans performed beyond 22 weeks gestation may limit the ability to seek pregnancy termination, depending on local legislation.

Two-dimensional (2D) is used to evaluate fetal structures, placenta, and amniotic fluid volume. Maternal pelvic organs are also evaluated. Views are obtained using an abdominal ultrasound probe, but a vaginal ultrasound probe may also be used to evaluate for placenta previa and cervical length. Three-dimensional (3D) ultrasound is not recommended for routine use during anomaly scan, but 3D ultrasound may be utilized to further evaluate suspected abnormalities in specific fetal structures.

 

Source : Wikipedia

Chorionic villus sampling (CVS), sometimes called "chorionic villous sampling" (as "villous" is the adjectival form of the word "villus"), is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus (placental tissue) and testing it for chromosomal abnormalities, usually with FISH or PCR. CVS usually takes place at 10–12 weeks' gestation, earlier than amniocentesis or percutaneous umbilical cord blood sampling. It is the preferred technique before 15 weeks.

Possible reasons for having a CVS can include:

  • Abnormal first trimester screen results
  • Increased nuchal translucency or other abnormal ultrasound findings
  • Family history of a chromosomal abnormality or other genetic disorder
  • Parents are known carriers for a genetic disorder
  • Advanced maternal age (maternal age above 35). AMA is associated with increase risk of Down's syndrome and at age 35, risk is 1:400. Screening tests are usually carried out first before deciding if CVS should be done.

Cordocentesis — also known as percutaneous umbilical blood sampling — is a diagnostic prenatal test in which a sample of the baby's blood is removed from the umbilical cord for testing.

 

Cordocentesis, which is usually done after week 18 of pregnancy, can be used to detect certain genetic disorders, blood conditions and infections. It can also be used to deliver blood and medication to a baby through the umbilical cord.

 

Use of cordocentesis is becoming rare because diagnostic procedures such as amniocentesis and chorionic villus sampling, which pose a lower risk of fetal death, can be used instead for prenatal diagnosis of disease. Cordocentesis is most often done to test for anemia in the baby.

Why it's done

Cordocentesis is used primarily to detect and treat blood conditions, such as fetal anemia — a low amount of healthy red blood cells in a developing baby.

 

Rarely, cordocentesis might be used to check fetal chromosomes through chromosome microarray or karyotype analysis. Blood obtained through cordocentesis can also potentially be used for other types of genetic studies.

 

Source: Mayo Clinic

Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. This fluid contains fetal cells and various proteins.

 

Amniocentesis can be done for various reasons:

  • Genetic testing. Genetic amniocentesis involves taking a sample of amniotic fluid and testing it for certain conditions, such as Down syndrome.
  • Fetal lung testing. Fetal lung maturity testing involves taking a sample of amniotic fluid and testing it to determine whether a baby's lungs are mature enough for birth.
  • Diagnosis of fetal infection. Occasionally, amniocentesis is used to evaluate a baby for infection or other illness. The procedure can also be done to evaluate the severity of anemia in babies who have Rh sensitization — an uncommon condition in which a mother's immune system produces antibodies against a specific protein on the surface of the baby's blood cells.
  • Treatment. If you accumulate too much amniotic fluid during pregnancy (polyhydramnios), amniocentesis might be done to drain excess amniotic fluid from your uterus.
  • Paternity testing. Amniocentesis can collect DNA from the fetus that can then be compared to DNA from the potential father.

 

Source : Mayo Clinic

A Follicular Study or Ovulation Study Scans are a series of scans that help you know when you are ovulating. Generally, these scans will start around day 9th of your cycle and continue till ovulation occurs. The doctor observes the follicle development occurring in your ovaries to calculate the exact time when the egg will be released. If a couple plans intercourse at that time, it maximizes the chances of conception. Sounds simple and easy? Not really.

 

A follicle scan should be done several times during a woman’s menstrual cycle, usually from days 9-20.  A basically painless procedure, a follicle scan lets the doctor see the development of the follicle within the ovary.  Using small plastic probes inserted in the vagina, sonographers are able to track the egg’s development within the follicle.

What Else Can Be Detected With This Scan?

Although it is a great tool for couples who want to have a baby, the scan can also determine some other problems which may be the root cause of why you are not getting pregnant.

 
  • Using the scan, the doctor will be able to identify the follicles that do not grow properly and rupture at an early stage.
  • The scan can also detect this condition. 
  • The scan also finds out if the follicles are not growing at all or are not rupturing at the right time to allow the fertilisation of the egg.

Using the scan, the doctor can check if you’re facing any of these conditions, and help you correct or prevent these from occurring.

Fetal echocardiography is a test similar to an ultrasound. This exam allows your doctor to better see the structure and function of your unborn child’s heart. It’s typically done in the second trimester, between weeks 18 to 24.

The exam uses sound waves that “echo” off the structures of the fetus’s heart. A machine analyzes these sound waves and creates a picture, or echocardiogram, of their heart’s interior. This image provides information on how your baby’s heart formed and whether it’s working properly.

It also enables your doctor to see the blood flow through the fetus’s heart. This in-depth look allows your doctor to find any abnormalities in the baby’s blood flow or heartbeat.

Why is this test important?

Abnormal results from fetal echocardiography can be inconclusive or require that you get more testing to find what’s wrong. Sometimes problems are ruled out and no further testing is needed. Once your doctor diagnoses a condition, you can better manage your pregnancy and prepare for delivery.

Results from this test will help you and your doctor plan treatments your baby may need after delivery, such as correctional surgery. You can also get support and counseling to help you make good decisions during the remainder of your pregnancy.

Source : Health Line

Pre-eclampsia is high blood pressure caused by pregnancy. It is one of the most common and life threatening conditions occurring in pregnancy and affects around 1 in 20 pregnant women.

Some of the risk factors for PE include:

  • maternal and paternal family history
  • previous pregnancy with pre-eclampsia
  • multiple pregnancy (e.g. twins)
  • maternal age (over 40 years)
  • body mass index (BMI) over 30
  • pre-existing high blood pressure, diabetes, smoking or kidney disease
  • systemic inflammation
  • ethnic origin.

Preeclampsia (PE) is an important cause of maternal and perinatal mortality and morbidity. Consequently, a major challenge in modern obstetrics is early identification of pregnancies at high-risk of preterm PE and undertaking of the necessary measures to improve placentation and reduce the prevalence of the disease. There is now evidence that a combination of maternal demographic characteristics, including medical and obstetric history, uterine artery pulsatility index (PI), mean arterial pressure (MAP) and placental growth factor (PlGF) at 11-13 weeks' gestation can identify a high proportion of pregnancies at high-risk for preterm PE. Such early identification of the high-risk group for preterm PE is important because the risk is substantially reduced by the prophylactic use of low-dose aspirin starting from 11-13 weeks.

Why should I be screened for pre-eclampsia?


Screening is a simple way to identify your risk of developing early-onset pre-eclampsia. Early detection and treatment can protect your baby and improve pregnancy outcomes. Without intervention, PE may affect the normal growth of the baby.

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