What Is Fetal Medicine?
Fetal medicine is the medical specialty encompassing testing for and treating a broad range of fetal pathologies and malformations. Sometimes referred to as maternal-fetal medicine (MFM) or perinatology, fetal medicine focuses on managing the health concerns of the fetus as well as the mother prior to, during, and shortly after pregnancy. It first emerged as a specialty in the 1960s, when advances in research and technology first made it possible for fetal complications to be discovered and sometimes treated in utero.
Structural and functional abnormalities are found to occur in an estimated 3% to 6% of all births worldwide, according to the Centers for Disease Control and Prevention (U.S.). Causes may be genetic factors, chromosomal defects, or environmental circumstances such as maternal nutrition and exposure to toxins or viruses during gestation.
Lack of timely prenatal care as well as effective critical care during and after birth can mean a high percentage of impaired fetuses are likely to die either at birth or in their first year of life. Indeed, in some countries birth defects are the leading cause of mortality in infants and young children. Of those who survive, their quality of life – depending on conditions and severity – is likely to be poor, and their treatments, which can include multiple surgeries, are both lengthy and expensive.
What Is Available?
Today, the range of tests and treatments that are available during gestation is quite broad. Several abnormalities can be detected as well as monitored and treated, reducing the need for more complex, lengthier, and invasive neonatal treatments. The right point of intervention as well as the type of intervention, however, can be crucial. In some cases intervention is more effective in utero, whereas other conditions benefit more from monitoring in utero and post-delivery (i.e., neonatal) intervention.
The prenatal screenings which can detect fetal impairments and abnormalities include amniocentesis, ultrasounds and MRIs, maternal blood plasma studies to detect for chromosomal abnormalities, and tests to determine the presence or absence of genetic diseases. A second group of prenatal screens, the Fetal Biophysical Profile (BPP), assesses fetal well-being and identifies fetuses that are potentially compromised. The tests examine heart rate with fetal movement, breathing movements, gross fetal body movement (“kick counts”), muscle tone, and amniotic fluid volumes. BPPs are especially recommended for pregnant women whose medical histories include high blood pressure, diabetes, autoimmune diseases, Rh incompatibility, prior early labor(s), premature rupture of membranes, or placental problems.
Screenings can also provide information about high-risk pregnancies where fetal impairment is not a factor. For example, fetal station or lie (the fetal position in the uterus), can be crucial, as transverse or breech pregnancies are high-risk. Finally, fetal screenings provide information that can enable effective transitions to neonatal care. This can be especially necessary for situations such as multiple fetus pregnancies, which comprise approximately 3% of all births in the U.S. and require close monitoring throughout gestation and after birth.
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