Times of India
24 April 2010
By Risha Chitlangia
New Delhi, India
From Just Diagnosis to Surgical Interventions, Fetal Medicine has Come A Long Way
When the Pandeys look at their twoyear–old daughter Avika playing with other children in the neighbourhood, Prashant and Harshita can’t help but thank god. Doctors had asked Harshita to terminate her pregnancy in the eighteenth week because the fetus had a large tumour in one of her lungs.
“The radiologist said the scan indicated a problem, that the baby might not survive. Doctors suggested an abortion,” recalled Prashant, who had consulted several doctors. Every one of them had the same thing to say..except for Dr Anita Kaul, senior consultant, fetal medicine at Indraprastha Apollo. “She was the only doctor who ruled out any serious complication, giving us the confidence to go ahead with the pregnancy,”said Prashant.
The tumour in Avika’s lung dissolved, on its own, soon after birth and today, she suffers from no medical complications.
Like Prashant and Harshita, many couples have been advised to terminate pregnancies because a scan indicated an abnormality. “With technological advances, we can now treat these cases in the womb,” said Dr Anita Kaul. But fetal medicine experts said there is a lack of awareness about this branch of superspecialty medicine among the general public and doctors.
Fetal medicine can be divided into two main branches: diagnostic and therapy. A detailed fetal scan will pick up structural and chromosomal anomalies which would otherwise have been missed. “Regular scans often miss heart defects. We screen a fetus from head to toe for an array of abnormalities. We can pick up Down’s syndrome; certain types of mental retardation, after studying family history; thalassaemia major; genetic disorders etc,” said Dr Vandana Chaddha, consultant, centre for fetal and genetic medicine, Moolchand Medcity.
Till a decade ago, the main focus of fetal medicine experts was diagnosis. Surgical interventions were rare. But now, experts are able to perform complicated procedures to save a fetus.
Dr Deepika Deka, professor, obstetrician and gynaecologist at AIIMS, who started the fetal medicine unit in 1986, has performed close to 600 blood transfusions on fetuses.“If the mother is Rhnegative, her immune system treats Rh–positive fetal cells as if they were a foreign substance and makes antibodies against the fetal blood cells. This results in lowering of haemoglobin in the fetus. Then we need to give O negative blood to the fetus through a transfusion,” said Dr Deka.
Doctors also play a crucial role in managing twins in the womb.“It is often seen that one twin gets more blood supply because of which the other is not able to grow. The twin that gets more blood supply has more amniotic fluid around it. So we balance out the amniotic fluid in order to up chances of survival of the other baby,” said Dr Chaddha. In some cases, one twin bleeds into the other. “In these cases, we need to cauterise the umbilical cord of the abnormal twin. Using fetoscopy, we enter the uterus from the abdomen and cauterise the umbilical cord,”said Dr Deka.
Experts said pregnant women should come in for a scan in the early stages of their pregnancy. &rdqu;We can pick up a fetal abnormality as early as the eleventh week of pregnancy. Early diagnosis leads to better prognosis,“ said Dr Deka. Dr Kaul agreed, saying, “Any fetal intervention can trigger off labour pain, so we need to be very careful. If a patient comes to us in in the eighteenth week, then we have little time to observe the fetus post surgicalintervention. We can’t abort a fetus after the twentieth week. Therefore, it’s important women come to us early.”
Another key role experts play is in helping women complete a full term of pregnancy. “Doctors often prefer to deliver a baby before term because they’re worried about intra–uterine death. But in the process they also risk the baby’s growth. Premature babies don’t do well and suffer from neurological disabilities. We want babies to spend a maximum amount of time in the womb because it helps in their neurological development. Only by keeping a fetus under observation, we can help the baby,” said Dr Kaul.