Fetal medicine is the part of obstetrics that looks after the baby as a patient in its own right. Most of that work happens through ultrasound: checking how the baby is formed, how it is growing and how well the placenta is supplying it. When a concern arises, it also covers genetic testing, counselling and, occasionally, treatment of the baby before birth.
Most pregnancies need only a few well-timed scans. The value of a fetal medicine service lies in getting each scan at the right week, interpreting it in the context of your own history, and having a clear next step if anything is not as expected.
Dr. Devang Patel is accredited by the Fetal Medicine Foundation (UK) for the nuchal translucency scan, holds the first FNB fellowship in High Risk Pregnancy & Perinatology awarded in Gujarat, and trained in 3D ultrasound and maternal-fetal medicine at Fernandez Hospital, Hyderabad. At Divine Women’s Hospital, Gota, scans are performed and reported by the consultant who will act on them, so findings are explained in the same visit.
What a fetal medicine specialist does
A fetal medicine specialist is an obstetrician with additional training in ultrasound, prenatal diagnosis and the management of complications that affect the baby. The role sits between routine antenatal care and the paediatric team who look after the baby after birth.
In practice, that means four kinds of work: screening every baby at key weeks, investigating when a screening result or scan finding raises a question, monitoring babies at higher risk of growth or placental problems, and planning birth - or occasionally treatment in the womb - when a condition is confirmed.
About 2–3 in every 100 babies are born with a significant structural or genetic condition, and most of these occur in families with no known risk factor. That is why screening is offered to every pregnancy, not only to women who are considered high risk.
The scan schedule through pregnancy
Each scan has a specific purpose and a window in which it is most useful. Missing a window, especially the NT scan, can mean losing information that cannot be recovered later. The detailed pages for each scan explain exactly what is examined.
| Scan | Usual timing | Main purpose |
|---|---|---|
| Dating and viability scan | 6–9 weeks | Confirms the pregnancy is in the uterus, the heartbeat, dates and number of babies |
| NT scan with combined screening | 11–13+6 weeks | Chance of chromosomal conditions, early anatomy, pre-eclampsia risk, twin chorionicity |
| Level II anomaly scan | 18–22 weeks | Detailed check of the baby’s structure, placenta and fluid |
| Fetal echocardiography | About 20–24 weeks, when indicated | Focused study of the baby’s heart |
| Growth and Doppler scans | 28 weeks onwards, as needed | Baby’s size, fluid and blood flow in the cord and brain |
| Cervical length scan | 16–24 weeks, when indicated | Risk of preterm birth |
| Twin surveillance scans | Every 2–4 weeks from 16 weeks | Growth and complications specific to twins |
Screening tests and diagnostic tests
Screening tests, such as the combined first-trimester test or a cell-free DNA (NIPT) blood test, give a chance - for example 1 in 1,000 or 1 in 50 - that a baby has a particular condition. They carry no risk to the pregnancy but cannot give a definite answer.
Diagnostic tests, such as CVS and amniocentesis, examine the baby’s own cells or genetic material and give a definite answer for the conditions tested, at the cost of a small procedure-related risk. Choosing between them, or choosing neither, is a personal decision made after counselling.
A low-chance screening result is reassuring but cannot rule everything out; a high-chance result is a reason for discussion, not a diagnosis.
Who benefits from a fetal medicine review
- Women whose NT, blood screening or NIPT result is reported as higher chance
- A structural finding or soft marker on any scan
- A previous baby with a structural, chromosomal or genetic condition
- Either partner carrying thalassaemia trait or another known genetic condition
- Close blood relationship between partners (consanguinity)
- Diabetes before pregnancy, epilepsy medicines or other exposures that affect the baby’s development
- Twin or higher-order pregnancies, especially when the babies share a placenta
- Rh negative mothers with antibodies, and previous small or stillborn babies
When a scan finds something
Many scan findings turn out to be minor or temporary. If something is seen, you will be told what it is, how certain the finding is, what it might mean and what the realistic options are - a repeat scan, a focused scan such as a fetal echo, a genetic test, or simply watching. Where it helps, the anatomy is drawn out on paper so the whole family can follow the discussion.
You are given time to think and to ask questions, and written reports are provided so you can take a second opinion if you wish. Indian law sets time limits for some decisions in pregnancy, which is one reason why scans at the recommended weeks, and prompt follow-up of findings, matter.
When a finding could have a genetic cause, the conversation includes what a genetic test might add, whether the result would change the plan for pregnancy or birth, and what it might mean for brothers, sisters or future pregnancies. Some couples want every possible piece of information; others prefer to focus on what will affect the baby’s care. Both approaches are respected.
Monitoring the baby later in pregnancy
In the third trimester the focus shifts from structure to wellbeing. Growth scans measure the baby’s head, abdomen and thigh bone to estimate weight, and Doppler studies of the umbilical and middle cerebral arteries show how well the placenta is working and whether the baby is adapting to any shortage.
A baby measuring below the 10th centile, fluid that is reduced or increased, or abnormal Doppler flow each leads to a different follow-up plan, from a repeat scan in two weeks to more frequent monitoring and early delivery. Reduced movements are always a reason for same-day assessment, whatever the last scan showed.
These scans are not routine for every pregnancy. They are planned when there is a reason: high BP, diabetes, a previous small baby, reduced movements, twins or a measurement that is smaller or larger than expected. The results guide how often to monitor and the right time for birth.
Planning birth for a baby with a known condition
When a condition is confirmed before birth, the timing, place and mode of delivery can be planned around the baby’s needs. For some heart, kidney, bowel or spine conditions, this means arranging paediatric surgical or cardiac input, or delivering in a centre with the specific services required.
For many findings, delivery at Divine Women’s Hospital with 24 × 7 obstetric and neonatal support is appropriate, with paediatric review arranged soon after birth. Selected conditions, such as severe fetal anaemia, can be treated before birth; this is covered on the fetal therapy and intrauterine transfusion page.
What ultrasound can and cannot do
Diagnostic ultrasound has been used in pregnancy for decades and is considered safe when used for a medical reason by trained operators, with the lowest exposure needed. No scan, however careful, can detect every condition.
- Some conditions, such as certain heart defects, brain changes or skeletal conditions, become visible only later in pregnancy
- Many genetic conditions, hearing loss and developmental conditions cannot be seen on ultrasound at all
- Image quality is affected by the baby’s position, the mother’s body build, scar tissue and the amount of fluid; a repeat visit is sometimes needed
- 3D images can help in selected situations but are an aid to, not a replacement for, the standard 2D examination
A note on the PCPNDT Act
Pre-natal sex determination is prohibited in India under the PCPNDT Act. The sex of the baby is not detected or disclosed at any scan.
Your care, step by step
- Book the right windowYour scan is booked at the week when it gives the most information, based on your dates and history.
- Scan by the consultantThe scan is performed and reported by Dr. Devang Patel, who will be responsible for any next step.
- Results in the same visitFindings are explained in Gujarati, Hindi or English, with a written report to keep.
- Next steps if neededFurther scans, genetic counselling, CVS or amniocentesis are arranged and explained before you decide.
- Birth planningWhere a condition is confirmed, delivery is planned with the obstetric and neonatal teams in advance.
When to book a visit
- You are due for your NT or anomaly scan
- Your screening test came back as higher chance
- A scan elsewhere showed a finding and you want it reviewed
- A previous baby had a structural or genetic condition
- You or your partner carry thalassaemia trait, or you are related by blood
- You have diabetes, twins, or a family history of congenital heart disease
Warning signs - get same-day care
- Reduced or absent baby movements after 24 weeks
- Vaginal bleeding at any stage of pregnancy
- Leaking fluid from the vagina
- Severe or constant abdominal pain
- Rapid increase in abdominal size with breathlessness, especially in twins
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Scans harm the baby, so fewer is better.
Diagnostic ultrasound at the recommended weeks is considered safe. Skipping key scans means losing important information.
Myth: A normal NT scan means the baby is perfectly healthy.
A normal NT scan is reassuring, but the anomaly scan at 18–22 weeks checks the baby’s structure in far more detail.
Myth: 3D or 4D scans are more accurate than routine scans.
The diagnosis is made on the standard 2D examination. 3D adds detail in selected situations only.
Myth: Any finding on a scan means something serious.
Many findings are minor, temporary or simple variants. Each is explained in context before any further test is suggested.
Frequently asked questions
Is ultrasound safe for my baby?
Diagnostic ultrasound has been used in pregnancy for decades and is considered safe when performed for a medical reason by trained operators, using the lowest exposure needed to get the information.
How many scans are needed in a normal pregnancy?
Most uncomplicated pregnancies need three main scans: an early dating scan, the NT scan at 11–13+6 weeks and the anomaly scan at 18–22 weeks. Growth scans are added when there is a specific reason.
What is the difference between a gynaecologist and a fetal medicine specialist?
Every obstetrician performs routine scans and antenatal care. A fetal medicine specialist has additional training in detailed ultrasound, prenatal diagnosis and managing complications that affect the baby.
Do I need a full bladder for the scan?
Early scans are sometimes clearer with a moderately full bladder. For scans after the first trimester it is usually not needed. You will be told when you book.
Can every problem be seen on a scan?
No. A careful anomaly scan picks up many major structural conditions, but some only become visible later in pregnancy and others, including many genetic conditions, are not visible on ultrasound at all.
What is a soft marker on a scan?
A soft marker is a minor finding, such as a bright spot in the heart or slightly prominent kidneys, that is common in healthy babies but can slightly change the chance of a chromosomal condition. Its meaning depends on your earlier screening results.
Can I bring my husband or family to the scan?
Yes, a family member is welcome. Many couples find it helpful to hear the explanation together, especially if a finding needs to be discussed.
Can I get my scan reviewed if it was done elsewhere?
Yes. Bring the report and any images. A review scan can confirm or clarify a finding, and the plan is explained to you in the same visit.
What should I bring to a fetal medicine appointment?
Bring all previous scan reports, blood test results including screening reports, your blood group, and any reports from previous pregnancies or genetic tests. A list of current medicines is also useful.
Will you tell me the baby’s gender on the scan?
No. Pre-natal sex determination is prohibited in India under the PCPNDT Act, and the sex of the baby is not detected or disclosed at any scan.