Fetal Medicine and its dialog with pregnancy.
Fetal medicine and its dialog with pregnancy
Pregnancy over the 40 weeks or 9months is a wonderful journey that gives the bliss of giving birth to a new life---It becomes indeed wonderful provided appropriate care and precautions are taken.By precautions we mean not only for the mother but also for the fetus or the baby inside the womb.In pregnancy we deal with two patients---mother and the baby inside her womb k/a fetus.
The expertise to know about the wellness of the unborn - fetus---is called fetal medicine.
What is fetal wellness?
Fetal wellness means good growth of the fetus who has no structural or chromosomal abnormalities which would lead to a birth of a healthy newborn.
Why is fetal medicine important?
One would argue that in earlier days when our parents or grand parents were born there was no such need to go to fetal medicine expert --so why do we need now?
The answer is that in those times 1. no technology, no expertise 2.they usually had more than 1 child whereas today most of us plan a single child or max two and 3. and then in those days many children died immediately after birth as we heard from our elders--no one knew why---may be they were abnormal----But now we have an answer to this may be’s…we can detect many abnormalities before the baby is born,,ie when it is inside the womb---a fetus.
The advantage to this is that the to be parents know what they are expecting and in cases where the abnormalities are severe or lethal they are given an option of termination of pregnancy under legal limits or if the parents opt for continuation---we respect that provided the mother is not at risk
How and when should we check for fetal wellness?
The wellness starts as early as in the pre-pregnancy and early pregnancy period.
Those families who have a previous affected child or an affected family member should come for pre-pregnancy counselling from a fetal medicine and genetics expert wherein they will be made to understand the nature of the disease or abnormality, the type of inheritance it follows and the risk of their child getting a similar disease…And lastly is there a way they can get a healthy unaffected child for sure?
Eg.. A couple with a previous child affected with a rare syndrome wherein the child’s skin sheds k/a junctional epidermolysis bullosa came to me ---they were very anxious and wanted to know if they can have a second normal or unaffected child---So when they got my answer as Yes they were indeed relieved---A CVS was performed at 12 weeks of next pregnancy, the causative gene was analysed and found to be non- mutated---- delivered a normal child.
SImilarly we had another couple wherein both had thalasammeia minor, a blood disorder----25% risk of getting child with thal major---repeated blood transfusions
50% risk of being like parents--thal minor, and 25% chance of being unaffected
So again we did a CVS and the child born is doing fine.
So for couples having a previous affected child or affected themselves or an affected family member should come for pre-pregnancy counselling.
For those who do not have any significant family history can first visit in early pregnancy.
Ultrasound at 5- 6 weeks is done to see a pregnancy sac (g-sac) and/or a food sac(yolk sac) and ultrasound at 7 weeks tos ee fetal pole and heartbeat.
This is important to rule out any ectopic pregnancy (outside the womb) and to see that the pregnancy sac is healthy.
At 11-13 weeks, a NT scan is done to look for features of chromosomal abnormalities especially Down syndrome.This can be combined with a blood test called dual marker to improve its efficacy.Those with HIGH risk for Down or T18/13 or a major anomaly are offered further tests like chorionic villus sampling or amniocentesis(invasive tests) to confirm or rule out the risk.
Anomaly scan is done at 18-20 weeks to rule out major detectable structural abnormalities in the fetus. Growth, placenta and amnioitc fluid are also looked at in this scan.
Wellness would also include making sure that the unborn is getting proper nutrition or growth is proper. And now we use Dopplers to study blood flows from various parts of the fetus like that of umbilical cord, brain, liver etc and also from the placenta.We also look for placental position, position of the fetus, amount of fluid around the baby etc in these scans.
All in all--
Meet fetal medicine expert at least four times in your pregnancy
1. At 6-7 weeks to confirm intrauterine pregnancy
2. NT scan at 11-13+6 weeks
3. Anomaly scan at 18-20 weeks
4. Fetal growth and Dopplers--At 32 weeks
Prepregnancy counselling if any one in family is affected including you
Special scans(neurosonogram, fetal echo etc) and invasive procedures as per the need
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