Maternal-Fetal Medicine

Maternal-Fetal Medicine (Perinatology) is a subspecialty within obstetrics that focuses on the comprehensive care of pregnant women who are at high risk for complications affecting the mother, fetus, or both. Maternal-fetal medicine (MFM) specialists, also known as perinatologists, are obstetricians with additional training in managing complex pregnancies through advanced diagnostics, preventive strategies, and therapeutic interventions.

High-Risk Pregnancy Management:

High-risk pregnancies may involve maternal conditions such as hypertension, diabetes, autoimmune diseases, renal disorders, infections, or obesity, as well as fetal concerns like growth restriction, structural anomalies, or genetic abnormalities. MFM specialists work closely with general obstetricians to coordinate multidisciplinary care, monitor the health of both mother and fetus, and intervene when complications arise. Their role is critical in reducing maternal and neonatal morbidity and mortality through early detection, targeted management, and precise delivery planning.

Fetal Imaging and Diagnostics:

Fetal imaging is a cornerstone of perinatal care. Advanced ultrasound techniques, including Level II anatomy scans, Doppler studies, and 3D/4D imaging, are employed to assess fetal development, placental function, and uterine blood flow. Additionally, fetal echocardiography is used to detect congenital heart defects, while MRI may be utilised for more detailed anatomical evaluations in complex cases. Regular imaging allows for continuous surveillance of high-risk pregnancies, especially those with intrauterine growth restriction (IUGR), amniotic fluid disorders, or structural anomalies.

Prenatal Genetics and Therapy:

MFM specialists lead the way in prenatal genetic screening and diagnostic testing. Non-invasive prenatal testing (NIPT) using cell-free fetal DNA is widely used to screen for chromosomal conditions such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13). Diagnostic procedures like chorionic villus sampling (CVS) and amniocentesis offer definitive genetic insights and are essential in families with a history of inherited disorders. Some MFM units also offer emerging fetal therapies, such as intrauterine transfusions for fetal anaemia, shunt placements for urinary obstructions, and even fetal surgery in select cases like spina bifida.

Labour Complications:

Maternal-fetal medicine consultants are often involved in managing labour and delivery complications, including preterm labour, placental abruption, abnormal presentations, shoulder dystocia, and uterine rupture. They also manage pregnancies complicated by multiple gestations (twins, triplets), which carry an increased risk of preterm birth and delivery-related complications. In such situations, they develop detailed birth plans, decide on the timing and mode of delivery, and ensure neonatal resuscitation support is readily available.

Conditions Treated:

• Pre-eclampsia and eclampsia
• Gestational diabetes mellitus
• Autoimmune disorders (e.g., SLE, antiphospholipid syndrome)
• Fetal growth restriction (IUGR)
• Congenital anomalies
• Placenta previa and accreta spectrum
• Infections like CMV, toxoplasmosis, and Zika
• Recurrent pregnancy loss
• Multiple pregnancies

Prevention and Screening:

Preventive strategies in MFM include preconception counselling, early folic acid supplementation, low-dose aspirin to reduce the risk of pre-eclampsia, cervical length screening to prevent preterm birth, and diabetes screening in early pregnancy. Surveillance protocols are tailored based on individual risk factors, ensuring timely interventions.

Treatments and Procedures:

• High-resolution fetal ultrasound
• Fetal echocardiography
• Amniocentesis and CVS
• Intrauterine transfusions
• Corticosteroids and tocolytics for preterm labour
• Maternal medication adjustments
• Specialised delivery planning for high-risk cases

In summary, maternal-fetal medicine provides vital expertise in safeguarding the health of both mother and fetus throughout complex pregnancies. Through proactive screening, advanced diagnostics, and specialised interventions, MFM specialists significantly improve outcomes for high-risk pregnancies.