About Fetal Medicine
Fetal medicine can be defined as new age medical intervention science that helps in the detection of birth defects in the fetus. This field of science provides the detection of most abnormalities in the baby before it is born. Fetal medicine also aids in the prenatal management and the diagnosis of the defect through surgery, delivery and care post birth (multidisciplinary team approach). This new age medical field is able to empower the expecting parents and the doctors of what lie ahead. Based on the detection the parents now have the choice of managing most fetal defects intrauterine. This procedure helps them save their bundle of joy and enjoy the blissful experience of motherhood. Paras Bliss has a specialised unit that provides a well formulated multidisciplinary approach to treat and detect fetal abnormalities. Paras Bliss’ department of Fetal Medicine in panchkula also plans the pregnancy of the complicated cases along with your obstetricians, neonatologists, paediatric surgeons and cardiologists.
Fetal medicine also includes multi disciplinary approach and support of various other departments to deliver the best care that you need.
At Paras Bliss, Fetal Medicine is further divide into two specialisations.
1.Prenatal Diagnosis and 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.
Paras Bliss, is the only centre for fetal medicine in Panchkula, and adjoining cities of Chandigarh and Mohali.
SCREENING TESTS IN FETAL MEDICINE
Due to the advancements in medicine, we now have numerous methods to screen and detect the abnormalities that may be present in the fetus. The special techniques help parents 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 hope and not blindly opting 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 us 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 increases the accuracy of the diagnosis of Down syndrome. Depending on the weeks of gestation , they are referred to as DUAL “quadruple” tests.Triple test is obsolete now a days as its efficacy is no more than flipping a coin
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 commonn 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-
Paras Bliss has a well developed and managed Fetal Medicine unit that is adept to peform a number of fetal medicine management interventions to ensure that your baby gets treated and delivered healthy. The team of specialists can perform a plethora of procedures that can be one at few locations in India
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 isoimmunised pregnancy(Rh nehgative mothers and Rh positive fetus with a fetomaternal exchange) or Pavovirus 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 unequal sharing. One twin ends up supplying blood to the other, due to which there is excess of blood in one twin to leading tomore 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 where out of concern 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 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.
