Maternal and fetal medicine (MFM) is the subspecialty within the field of obstetrics and gynecology that deals with the complications of pregnancy. The problems are varied but can fit into one of several categories:
- Maternal disease: either the disease or the treatment may affect the fetus or pregnancy (e.g., diabetes and hypertension).
- Disease arising as a result of the pregnancy (e.g., preeclampsia and gestational diabetes)
- Abnormalities of the fetus (e.g., birth defects) or of fetal growth
- Genetic disease that has no meaningful effect on fetal life but that may affect the life of the individual after birth (e.g., cystic fibrosis or Down syndrome)
- Abnormalities of the pregnancy (e.g., prematurity)
Fetal ultrasound is a tool that is used in every category listed because it can provide a wealth of information concerning fetal condition, or it can provide guidance for intrauterine tests and treatments. Other tools used in MFM are the tools used by all physicians in the evaluation of a patient, such as taking a medical history, performing a physical examination, using laboratory testing, and using various imaging techniques on the mother.
Training in MFM requires completion of a 3-year fellowship. Completion of a 4-year residency in obstetrics and gynecology is a prerequisite for fellowship training.
MFM specialists practice in a variety of situations. Private practice of the specialty is common, but MFM specialists may be hired by hospitals or managed care organizations and can be found on the faculties of medical schools. The MFM specialist is often involved in teaching and research. Other aspects of obstetrics and gynecology may be practiced along with MFM, and it is not uncommon for the MFM specialists to give complete obstetrical care to patients with specific problems.
Historically, successes in the treatment of pregnancy complications came with the ability to diagnose, treat, and ultimately prevent fetal disease related to Rh incompatibility. Care of the pregnant diabetic woman was begun in the 1930s. The modern treatment of the diabetic pregnant woman began in the 1970s. It was realized then that very tight control of maternal blood glucose could prevent many problems, of both the mother and the fetus, which had otherwise been so devastating. Hypertensive disease in pregnancy remains a problem, but management generally allows a good outcome. The advent of the acquired immune deficiency syndrome (AIDS) epidemic required much research into the factors related to spread of the virus to the fetus.
Increases in the resolution of ultrasound have had a dramatic effect on the methods used. It is now possible to estimate the risk for Down syndrome by visualization of the thickness of the skin of the fetal neck at 12 weeks’ gestation, and current research is assessing use of the size of the fetal nasal bone in the first or second trimester for the same indication. Three dimensional visualization is commonly available, and we continue to try to identify ways to exploit new technology in fetal diagnosis.
Treatment of the fetus is often accomplished with the control of the maternal problem. Although some treatments include delivery of a fetus before complications cause fetal injury, in other situations we may also attempt to prevent a premature delivery. Antiarrhythmic drugs may be given to the mother to control problems with the fetal heart rhythm, and fetal surgery done on the fetus may confer striking benefits in the relatively rare situations in which it is indicated. In some cases, the treatment options are profoundly limited or the situation is judged hopeless. Termination of pregnancy may be deemed appropriate by the parents in these circumstances.
References:
- Creasey, R., Resnick, R., & Iams, J. (2004). Maternal-fetal medicine. Philadelphia: WB Saunders.
- March of Dimes. (2004). Diabetes in pregnancy. Retrieved from http://www.modimes.org/printableArticles/168-1197.asp?printable=true
- Mayo Clinic. (2003). Ultrasound in pregnancy: What can it tell you? Retrieved from http://www.mayoclinic.com/ invoke.cfm?id=PR00054
- Nyberg, D., McGahan, J., Pretorius, D., & Pilu, G. (2002).Diagnostic imaging of fetal anomalies. Philadelphia: Lippincott Williams & Wilkins.