Maternal-Fetal Medicine

Maternal Fetal Medicine (MFM) constitutes an intricate domain of medicinal expertise, concentrating on the stewardship of maternal and fetal wellbeing during gestation. This particular discipline grapples with precarious pregnancies and convoluted gestational scenarios, wherein the likelihood of complications affecting mother or offspring escalates. MFM adepts are medical practitioners who have accomplished their obstetrics and gynecology residency, subsequently pursuing further mastery within the MFM subspecialty.  (1) (2)

A noteworthy datum reveals that, upon receiving proactive intervention between 14-24 weeks of gestation, a minimum of one infant in 90% of instances endures fetal surgery to rectify the Twin-to-Twin Transfusion Syndrome (TTTS) anomaly, while over 80% of both neonates prevail through the remedial process. MFM experts are occasionally referred to as perinatologists or Maternal Fetal Medicine physicians. They possess unparalleled proficiency in ultrasonography, fetal surveillance, and intricate surgical procedures. (3) (4)

Definition and Overview

Maternal-fetal medicine (MFM), additionally known as fetal/fetal medicine, focuses on addressing health issues that a mother and fetus may experience before, throughout, and right away following pregnancy. Fetal medicine is additionally referred to as perinatology. Obstetricians and gynecologists that specialize in fetal medicine are taught how to assess and handle high-risk pregnancies. These experts have in-depth knowledge of all types of pregnancy issues, including genetic, surgical, and medicinal ones.

MFMs examine the uterus and the developing fetus using technologies like ultrasound, blood testing, and amniocentesis. To check for birth abnormalities and chromosomal problems they employ modern techniques in fetal echocardiography, 3D and 4D ultrasound, and fetal imaging. In addition, they work together with genetic counselors to offer procedures including integrated screening, amniocentesis, chorionic villus sampling, and non-invasive prenatal testing. (5)

Procedures

Maternal-Fetal Medicine procedures encompass a wide range of diagnostic and therapeutic interventions aimed at managing high-risk pregnancies. These procedures include

• Diagnostic amniocentesis

During an amniocentesis, the amniotic fluid is extracted from the uterus using a needle inserted transabdominally into the abdomen.

Since amniotic fluid contains a significant amount of urine, secretions, exfoliated cells, and transudate—all fetal components—it can be used in laboratory testing to evaluate the health of the fetus. 

In cases of symptomatic polyhydramnios or twin-twin transfusion syndrome, amniocentesis is also done as a therapeutic procedure to remove excess amniotic fluid. It is also done in cases of prolapsed fetal membranes in the second trimester to reduce the volume and pressure of the amniotic fluid and make it easier to place a cerclage that has been recommended by a physical examination.

• Therapeutic amniocentesis

It is done to reduce the amount of amniotic fluid in women with polyhydramnios complaints within the scope of therapeutic application. Polyhydramnios is an excessive accumulation of amniotic fluid. There is a higher chance of early pregnancy morbidity and mortality as a result. It is used in oligohydramnios (too little amniotic fluid), to prevent fetal lung hypoplasia and umbilical cord compression during delivery.

• Chorionic villus sampling (CVS) 

During chorionic villus sampling (CVS) or chorionic villus biopsy, a prenatal diagnostic procedure used for checking for chromosomal abnormalities and other genetic problems, a tissue sample from the placenta is obtained.

The placenta, an organ in the womb, carries blood and nutrients from the mother to the fetus.

The same genetic material as the fetus is present in chorionic villi, which are tiny extensions of placental tissue that resemble fingers. Testing for further genetic illnesses and flaws may be carried out, depending on family history and the availability of laboratory tests at the time of the surgery. (6)

Candidates

Patients in Maternal-Fetal Medicine (MFM) are those whose pregnancies have been classified as high-risk or who need specialist care because of complicated maternal or fetal disorders. MFM procedures are generally suitable for women 

• of advanced maternal age,
• with low blood counts or clotting problems,
• with digestive system problems,
• with endocrine conditions, 
• having extra body fat/obesity,
• with chronic lung problems,
• with heart conditions. (7)

Risks and Side Effects

Risks and side effects are possible with any invasive operation. While they are not the only ones, the following complications may occur:

• heavy bleeding, 
• bloodstream infections, 
• surgical complications, 
• seizures,
• cramping,
• leaking of amniotic fluid,
• miscarriage
• preterm labor
• limb defects in infants. (8,9)

Post-Procedure and Follow-up

The amniocentesis procedures and chorionic villus sampling (CVS) procedures are different from each other. 

After the chorionic villus sampling (CVS) procedure, the patient and his fetus are kept under observation for a while. Vital signs and fetal heart rate are checked periodically for an hour or more. It is normal to experience mild cramping and light spotting for a few hours after CVS. 

The patient should avoid intense activity and relax at home for at least 24 hours.

Alpha-fetoprotein, a protein produced by the fetus and present in the fluid, can be tested following amniocentesis operations to rule out an obvious neural tube lesion like spina bifida. Tests may also be done for other substances related to metabolic or genetic conditions. There may be a recommendation to speak with a geneticist based on the test results.

Rest at home after the examination, and refrain from intense activity for at least 24 hours, or as instructed by a medical professional.  (10,11)

Recovery

In the chorionic villus sampling (CVS) recovery process, do not shower or have sexual intercourse for 2 weeks unless directed by a doctor. If experienced, leakage or bleeding of amniotic fluid from the needle entry site or vagina, fever and/or chills, severe abdominal pain and/or cramps should be reported to the doctor.mIf a transabdominal was performed, the bandaged needle site on the abdomen should be checked for any bleeding or fluid drainage. Depending on the patient's particular situation, the doctor may give additional or alternative instructions after the procedure.

In general, people who undergo amniocentesis operations recover quickly and can return to their regular activities in a day or two.For better recovery, any bleeding from the needle puncture site or vagina or leakage of amniotic fluid, fever or chills, severe abdominal pain and/or cramping, or changes in the fetus' activity level should be reported to the healthcare provider immediately.

Results

During a high-risk pregnancy, maternal-fetal medicine (MFM) techniques frequently produce the best possible health and well-being for the mother and fetus. MFM procedures may vary depending on the individual circumstances of each pregnancy and the underlying maternal or fetal conditions. To achieve the best outcome for high-risk pregnancies, these procedures strive to offer comprehensive and personalized care.