Fetal Medicine & Maternal Medicine
Fetal medicine is a branch of medicine that includes the
assessment of fetal growth and wellbeing, the maintenance of fetal
health and the diagnosis of fetal illnesses and abnormalities.
As prenatal diagnosis has improved, so has our capability to
diagnose problems before birth. Therefore, the fetus is increasingly
becoming an independent individual, and fetal medicine is the specialty
that addresses this "unborn patient".
Fetal medicine is a relatively new specialty that often requires
the expertise and input from various specialists, including
obstetricians, perinatologists (also called maternal-fetal medicine
specialists), neonatologists, pediatric cardiologists, pediatric
surgical specialists, geneticists and others.
Fetal medicine can be arbitrarily divided into two branches:
Prenatal diagnosis and 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. Other
modalities include non-invasive and invasive screening and diagnostic
A) Screening studies are relatively simple and inexpensive tests
aimed at detecting all cases of a particular anomaly within a relatively
large "at risk" population. Examples are screening for spina bifida and
- Maternal Serum Alpha-Fetoprotein, or MSAFP, is a maternal
blood test that may help detect spina bifida (also called
myelomeningocele or open neural tube defect).
- Nuchal translucency is a distinct finding on ultrasound
examination of the fetal neck, that may suggest the possibility of Down
syndrome (but is not a very accurate test in itself).
- Adding certain blood tests (including MSAFP) increases the
accuracy of the diagnosis of Down syndrome. Depending on the number of
screening tests, they are referred to as "combined", "triple" or
B) Non-invasive diagnostic tests include:
- Maternal blood tests for specific conditions, or to look for
- Two- and three-dimensional ultrasound
- Doppler ultrasound
- Cardiotocography and echocardiography of the fetus
- Magnetic resonance imaging (MRI)
C) Invasive diagnostic 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
fetoscopy. The most common invasive tests are:
- Chorion villus sampling
- Umbilical cord sampling (cordocentesis, funipuncture,
percutaneous umbilical blood sampling, or PUBS)
Fetal treatment or fetal therapy includes a series of
interventions performed on the "sick" fetus with the aim of achieving
fetal well being. These interventions include medical (i.e.
non-invasive) and surgical procedures.