The rapid technological advances in medicine have led to an improved ability to observe and monitor pregnancies and thus an increasing capability to diagnose a baby’s health and problems before its birth. The Fetus or Foetus is therefore increasingly seen as an independent individual and foetal medicine is the specialty that deals with the health and care of this unborn baby.

It is a relatively new specialty that often requires the expertise of a team which includes several specialists; including obstetricians, specialized ultrasonologists, perinatologists (also called maternal – foetal medicine specialists), neonatologists, paediatric cardioologists, paediatric surgical specialists, geneticists, and others.

Who requires Foetal Medicine?

Every pregnancy can benefit from foetal medicine in addition to obstetrics and gynaecology. Globally, 2 – 3 out of every 100 children are born with birth defects. If identified, many of these birth defects can be prevented. The benefits of foetal medicine include,

• Screening for genetic/ chromosomal defects
• Providing reassurance and reducing anxiety especially among high-risk groups
• Prediction and prevention of preterm birth/ foetal growth restriction and problems of multiple pregnancies
• To inform and prepare the parents for the birth of an affected child
• To allow inutero treatment
• Plan for transfer to a tertiary care centre
• Discontinue pregnancy with an affected foetus

What does Foetal Medicine involve?

In addition to patient and family counselling regarding the foetal condition, there are different aspects of foetal medicine which include non-invasive/ invasive screening and diagnostic studies:

Non-Invasive testing

Ultrasonography – grayscale/ 2D/ 3D/ 4D with Colour Doppler is the most common and often first test used for prenatal diagnosis. This test creates an image of the foetus in the mother’s womb. During a foetal ultrasound, various parts of the baby such as the heart, head, and spine are identified and measured. The testing may be performed either through the mother’s abdomen (transabdominal) or vaginal canal (transvaginal). Foetal ultrasound provides a safe way to evaluate the health of an unborn baby.

There are several types of foetal ultrasounds, each with specific advantages in certain situations. A Colour Doppler ultrasound, for example, helps to study the movement of blood through the umbilical cord between the foetus and placenta. A 3-D scan provides a life-like image of an unborn baby.

Other tests include,

• Foetal heart evaluation by echocardiography

• Foetal Magnetic resonance imaging (MRI)
• A Blood test – of the mother is done at different timings during pregnancy to evaluate the growing foetal characteristics and assess several serious foetal afflictions including chromosomal foetal abnormalities like Downs Syndrome/ spinal cord defects in the fetus.

• At 10 – 13 weeks: Dual test
• At 16 – 20 weeks: Quadruple/ Triple Test
• NIPT (Non-invasive Prenatal testing) of cell-free Foetal DNA in mother’s blood

Invasive testing

These tests require a form of surgical intervention, ranging from the insertion of a fine needle into the uterus under ultrasound guidance, to more invasive procedures such as foetoscopy. The most common invasive tests are:

• Amniocentesis – taking about 20 ml fluid from the sac around the baby and sending the foetal cells/ fluid for analysis.
• Chorionic villus sampling – taking a little placental tissue and sending the placental cell fluid for genetic analysis.
• Umbilical cord sampling – Also known as cordocentesis, funipuncture, percutaneous umbilical blood sampling, or PUBS.

Can Foetal Disorders be treated before birth?

Foetal treatment or foetal therapy includes a series of interventions performed on the ‘sick’ foetus with the aim of achieving foetal well-being. These interventions include medical (i.e. non-invasive) and surgical procedures which can treat or mitigate several disorders. There are, however, some disorders which cannot be treated and in which case doctors can help families prepare for the care of such a child or plan for a termination.

Dr. Mamta Mehrotra

MS (Obstetrics and Gynaecology), DNB (Obstetrics and Gynaecology), PGDS, FMF (London) Accredited

Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu