Maternal-fetal medicine

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Maternal-fetal medicine (MFM) is the branch of obstetrics that focuses on the medical and surgical management of high-risk pregnancies. Management includes monitoring and treatment including comprehensive ultrasound, chorionic villus sampling, genetic amniocentesis, and fetal surgery or treatment. Obstetricians who practice maternal-fetal medicine are also known as perinatologists. This is a subspecialty to obstetrics and gynecology mainly used for patients with high-risk pregnancies.[1] Obstetric medicine is a closely related specialty that emphasizes the care of medical problems in pregnancy.

Maternal-fetal medicine specialists are obstetrician-gynecologists who undergo an additional 2–3 years of specialized training in the assessment and management of high-risk pregnancies. As a result, they are able to take care of pregnant women who have special medical problems (e.g. heart or kidney disease, hypertension, diabetes, and thrombophilia), pregnant women who are at risk for pregnancy-related complications (e.g. preterm labor, pre-eclampsia, and twin or triplet pregnancies), and pregnant women with fetuses at risk. Fetuses may be at risk because of chromosomal or congenital abnormalities, maternal disease, infections, genetic diseases, and growth restriction.[2]

Maternal-fetal medicine specialists have training in obstetric ultrasound, invasive prenatal diagnosis using amniocentesis and chorionic villus sampling, and the management of high-risk pregnancies. Some of them are further trained in the field of fetal diagnosis and prenatal therapy where they become competent in advanced procedures such as targeted fetal assessment using ultrasound and Doppler, fetal blood sampling and transfusion, fetoscopy, and open fetal surgery.[3][4]

The field of maternal-fetal medicine is one of the most rapidly evolving fields in medicine especially in what concerns the fetus. Research is being carried on in the field of fetal gene and stem cell therapy in hope to provide early treatment for genetic disorders,[5] open fetal surgery for the correction of birth defects like congenital heart disease,[6] and the prevention of preeclampsia.

Many pregnancies have led to maternal mortality and maternal morbidity. This line of concern is most recommended to be situated with maternal-fetal medicine (MFM) subspecialists, in order to decrease the rate of maternal mortality and maternal morbidity.[7] The Society for Maternal-fetal Medicine (SMFM) strives to improve maternal and child outcomes by standards of prevention, diagnosis and treatment through research, education and training.[8] In order for MFM subspecialists to help reduce the rate of maternal death, they must receive adequate training and education. Research is essential for treatment. MFM subspecialist’s area of focus is early diagnosis of fetal abnormalities, non-invasive prenatal diagnosis, intrauterine fetal surgery, complex multiple pregnancy issues and the pathogenesis and early diagnosis and treatment of pre-eclampsia and fetal growth restriction.[9]

The American Board of Obstetrician Gynecologists (ABOG) has been recently adjusting education and training requirements to improve the knowledge in Maternal-fetal medicine. MFM subspecialists are now required to do a minimum of 12 months clinical rotation and 18 month research activities. They are encouraged to use simulation and case-based learning incorporated in their training, a certification in advanced cardiac life support (ACLS) is required, they are required to develop in-service examination and expand leadership training. Obstetrical care and service has been improved to provide academic advancement for MFM inpatient directorships, improve skills in coding and reimbursement for maternal care, establish national, stratified system for levels of maternal care, develop specific, proscriptive guidelines on complications with highest maternal morbidity and mortality, and finally, increase departmental and divisional support for MFM subspecialists with maternal focus. As Maternal-fetal medicine subspecialists improve their work ethics and knowledge of this advancing field, they are capable of reducing the rate of maternal mortality and maternal morbidity.[10]

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References[edit]

  1. ^ "About SMFM". Society for Maternal-Fetal Medicine. Retrieved 21 September 2012. 
  2. ^ "Curriculum for Subspecialty Training in Maternal and Fetal Medicine". Royal College of Obstetricians and Gynaecologists. 2007. Retrieved 21 September 2012. 
  3. ^ "Fellowship in Prenatal Diagnosis and Fetal Therapy | The Children's Hospital of Philadelphia". Chop.edu. Retrieved 28 May 2012. 
  4. ^ "Fetal Medicine Unit". Instituteforwomenshealth.ucl.ac.uk. Retrieved 28 May 2012. 
  5. ^ Abi-Nader Khalil N, Rodeck Charles H, David Anna L. Prenatal Gene Therapy for the Early Treatment of Genetic Disorders. Expert Review of Obstetrics and Gynecology 2009;4(1):25-44
  6. ^ Hanley FL. Fetal Cardiac Surgery. Adv Card Surg 1994;5:47-74
  7. ^ Brown, Haywood; Small Maria (February 2012). "The Role of the Maternal–Fetal Medicine in Review and Prevention of Maternal Deaths". Seminar in Perinatology 36 (1): 27–30. doi:10.1053/j.semperi.2011.09.006. 
  8. ^ Schubert, Kathryn G.; Cavarocchi Nicholas (December 2012). "The Value of Advocacy in Obstetrics and Maternal-fetal Medicine". Current Opinion in Obstetrics and Gynecology 24 (6): 453–457. doi:10.1097/gco.0b013e32835966e3. Retrieved 1 April 2013. 
  9. ^ Tan, Woo S.; Guaran Robert, Challis Daniel (November 2012). "Advances in Maternal Fetal Medicine Practice". Journal of Paediatrics and Child Health 48 (11): 955–962. doi:10.1111/j.1440-1754.2012.02596.x. 
  10. ^ Dalton, Mary E.; Bonanno Clarissa A., Berkowitz Richard L, Brown Haywood L., Copel Joshua A., Cunningham Gary F., Garite Thomas J., Gilstrap III Larry C., Grobman William A., Hankins Gary D.V, Hauth John C., Iriye Brian K., Macones George A., Martin James N., Martin Stephanie R., Menard M. Kathryn, O'Keefe Daniel F., Pacheco Luis D., Riley Laura E., Saade George R., Spong Catherine Y. (1 December 2012). "Putting the "M" Back in Maternal-Fetal medicine". American Journal of Obstetrics and Gynecology. Retrieved 1 April 2013. 

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