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What Is Fetal Medicine?

Welcome to the Fetal Medicine Centre at Apollo Gleneagles Hospitals, Kolkata. Fetal medicine is a sub-speciality branch of obstetrics, which assesses the health and safety of an unborn child:

  • To ensure birth of a healthy and normal child in most cases.
  • In case if any correctable abnormality is identified in fetus in utero , steps can be taken in good time for safe delivery and correction after birth. In some cases Therapeutic intervention is possible in utero to correct an abnormality
  • If it has been proved beyond doubt that the unborn child may have an abnormality which is lethal or may be associated with major mental or physical handicap not compatible with a normal life - an early diagnosis will ensure termination of pregnancy on informed consent of parents to prevent its squeal
  • In situations where fetal wellbeing of an otherwise normal child may be challenged due to maternal medical problems or growth related issues in fetus, appropriate timely intervention may ensure good outcome of pregnancy .

Fetal medicine is now an integral part of all obstetric patients - low or high risk . Thus, we work with your obstetrician to ensure the healthiest pregnancy possible for you and your baby.

Application of Fetal medicine may be screening ,Diagnostic or therapeutic .

Screening in Fetal medicine applies Biochemical ( Serum Based Tests ) and Biophysical ( USG ) Methods along with appropriate history .

Diagnostic tests involve Cytogenetic and Molecular Biology tests in fetal tissue samples obtained by Invasive methods

Therapeutic Interventions are usually invasive and its role is ever increasing.

Our evaluation and management of high-risk pregnancies includes comprehensive care and medical services for mothers and their unborn babies. Our maternal-fetal medicine physicians (perinatologists) have undergone advanced training in fetal evaluation and in-utero diagnostic and treatment procedures. They have advanced training in the evaluation and management of mothers with medical conditions that may impact or be affected by the pregnancy.

When you learn that you may need specialized pregnancy care, the medical professionals at Apollo Gleneagles Hospitals stand ready to meet your unique needs. Our experienced physicians, nurses and staff work together as a team to provide you and your baby with high quality, compassionate care.

Care is multidisciplinary with all staff working together to provide families with the best possible care and support. The team works closely with other health practitioners including obstetricians, neonatologists (baby doctors), cardiologists and geneticists. We offer state of the art services and work together with your obstetrician to manage the complications and limit the risks.

Apollo Gleneagles Hospitals, offers a complete range of health care services for women and babies including:

  • Comprehensive prenatal care through our network of physicians
  • A warm, homelike birthing center
  • High-risk pregnancy care for those experiencing complications
  • Dedicated obstetrical operating services
  • Advanced neonatal intensive care with certified neonatologists on-site
  • A full complement of educational classes on childbirth and parenting
  • And much more...

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This brochure provides a brief, general overview of some of the specialized services we offer to mothers-to-be and their babies.

Specialized Care for Babies

When your newborn has special needs (prematurity, respiratory distress, birth defects, vision problems), our Level 3 Neonatal Intensive Care Unit (NICU) and its team of Neonatologists utilize state-of-the-art technology to provide optimal medical care for your baby.

Services offered by the AGHL Fetal Medicine

Women who face complications during their pregnancy can rely on the expertise of AGHL's Fetal Medicine and Obsterics Unit.

Screening in Fetal medicine - Should always be universal for all pregnant women

Screening for Aneuploidy

  • First Trimester Screening ( FTS ) involving Nuchal Translucency Scan and Maternal Serum Double Marker Test at 11-14 weeks of pregnancy with a detection rate upto 98 % Or
  • Second trimester Screening - involving fetal biometry and maternal serum quadruple marker test at 16-21 weeks of pregnancy with a detection rate upto 80 %

NIPT (Non Invasive Prenatal Testing): NIPT is a DNA test on maternal blood to screen pregnancies for the most common fetal chromosome anomalies: trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome). The test can be done from gestation week 10.

Although NIPT can be performed in every pregnancy, it is especially indicated:

  • If the triple test or first trimester screening indicates an increased risk for Down syndrome, trisomy 18 or trisomy 13
  • Advanced maternal age

Screening for Thalassemia

Parental HPLC for Haemoglobinopathy carrier status and Mutation analysis by gene sequencing , if both parents are positive for carrier status

Screening for Structural Problems in fetus

Fetal Anatomy / Anomaly Scan - 4 % of all pregnancies will have a major handicap . Another significant portion will have relatively less severe problems - but important to know before birth. A structured USG at 18-22 weeks will identify 70-100 % of an anatomical problems in fetus .

Screening for Fetal wellbeing assessment

A mandatory assessment of fetal growth , liquor volume and fetal blood flow study is recommended in all cases at 32-34 weeks This will help to decide timing and mode of delivery.

In addition , multiple serial fetal wellbeing assessment is recommended In high risk or complicated pregnancies after 24 weeks till delivery to ensure safety of mother & fetus

Other screening Tests in fetal Medicine - with specific role in high risk cases.

  • Fetal echocardiography

Diagnostic Tests in Fetal medicine for confirmation of a genetic illness :

Amniocentesis / CVS - for screen positive cases from 1st or 2 nd trimester, for carrier couple of single gene disorders like thalassemia or couple with family history of a genetic disease (though virtually pre-natal diagnosis of all major genetic illness is possible in our country now ).

Therapeutic Interventions in Fetal medicine - the list is long - common ones are

  • Intra-uterine Fetal Transfusion
  • Interventions in Twin to twin Tansfusion
  • Selective Fetal Reduction

Fetal Medicine Clinic

1. Double Marker Screening / FTS

  • Gestation 11-14 weeks / CRL 45-84 mm
  • Women of all age groups

2. Quadruple Marker Screening

  • Gestation 16-21 weeks / BPD 33-52 mm
  • Women of all age groups

3. NIPT (Non-invasive Prenatal Testing)

4. Anatomy Scan / Fetal Wellbeing Assessment Scans :Will be performed for all pregnant women between 18-22 weeks. Fetal Wellbeing Assessment

  • Will be performed for all pregnant women between 32-34 weeks.
  • In addition, if any additional scan is indicated , it will be mentioned in Anatomy scan report - depending on merit of report. Additional scans may also be performed on request of referral doctors or in emergency indications.

5. Fetal echocardiography: if there is any specific indication, it will be arranged at 24 weeks

6. Peripheral Blood Karyotyping: for recurrent pregnancy loss

7. Product of Conception - FISH / Microarray or BOB: for recurrent pregnancy loss

Ultrasound

The centre provides specialised ultrasound scans and counselling for women with high risk and low risk pregnancies.

Sex determination is a punishable offence and not practiced here.

Our Fetal Medicine Unit and staff are trained and licensed under the PNDT Act 1994 perform ultrasound examinations, including first trimester evaluations, and detailed 4D screenings.

Genetic Counseling

Genetic counselors are trained professionals who can also provide detailed information about the combined ultrasound and serum screening test for birth defects to patients and their health care providers. The genetic counseling staff at the FM Centre at AGHL welcomes your questions.

Prenatal testing

The centre offers both chorionic villus sampling (CVS) and amniocentesis for women wishing to have testing for chromosomal disorders such as Down syndrome. Prenatal testing is also available for known genetic defects such as cystic fibrosis.

Amniocentesis

A physician will remove a sample of amniotic fluid (baby's urine) from the sac around the baby. The sample can be used for diagnostics (test for genetic abnormalities, maturity of the baby's lungs, infections, anemia), or to treat excess fluid around the baby.

Fetal Well-Being Tests (FWB)

Theses tests are used to determine how well your baby is being supported by the placenta. Common FWB tests are the non-stress test (NST) and bio-physical profile (BPP). NST uses a monitor to record the fetal heart rate and its response to fetal movement. BPP uses ultrasound to monitor fetal activities (movement, tone, breathing), and assess amniotic fluid volume.

Fetal heart scans

Fetal heart scans, also known as fetal echocardiography are a detailed assessment of the baby's heart. A paediatric cardiologist attends the ultrasound scan to assist in the diagnosis of heart abnormalities and also to provide counseling.

The centre works closely with the Cardiology Department at the Hospital. This assists in the planning of after birth care of babies with a cardiac defect.

Fetal surgery

Fetal surgery is a rapidly developing area that can offer new treatment possibilities in-utero.

Counseling

The diagnosis of a fetal abnormality or other pregnancy problem can be a difficult time for parents. Counseling by the multidisciplinary team provides these women and their families with detailed information and offers ongoing support.

Case management

The obstetrics team works closely with Fetal Medicine specialists and the multidisciplinary team to ensure that care is individualized and coordinated. They offer families a primary point of contact for information and support.

Research and education

The centre is internationally recognized for research and training in maternal fetal medicine. Women may be asked to participate in ongoing research projects-participation is voluntary and only after informed consent has been provided. Previous research studies have resulted in improvements to the care of complex pregnancies.

Referrals

A referral from a doctor is required to access services provided by the centre. Each ultrasound scan usually requires a new referral. Women should access her obstetrician prior to being referred to the centre, so that ongoing care can be coordinated.

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