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Fetus and Mother


A high risk mother is one who may have medical or pregnancy-related problems such as diabetes, high blood pressure, renal conditions, etc. Such mothers are at a higher risk of developing problems with the placental circulation and hence, intra-uterine growth restriction (IUGR) or sometimes increase in the fetal growth (usually seen with diabetic mothers).

At Kokilaben Hospital, we have a fully certified Specialist in Maternal & Fetal Medicine (Royal College of Obstetricians & Gynaecologists, UK)

The assessment would include:
  • Assessment of the 'high risk'pregnant mother
  • Assessment of the unborn fetus
  • Guidance about monitoring the pregnancy
  • Timing of the delivery and other aspects

This would involve a Consultation, a maternal health assessment, a fetal ultrasound scan and a Non-stress test (cardiotocography) to check the fetal health. All such cases need not be delivered at Kokilaben Hospital. We can liaise with the referring Obstetrician so that optimum outcomes for the mother and fetus are achieved.

Assessment of the High Risk Fetus and Mother

These diagnostic procedures for prenatal diagnosis are required in the following cases:

  • A high-risk screening result from a test for Down Syndrome (either a First trimester or Second trimester screening)
  • If women have missed their screening test for Down Syndrome and they are over a certain age (typically over 35 years)
  • Increased Nuchal Translucency or NT
  • An ultrasound scan at 20 weeks has picked up a fetal abnormality like a heart defect which indicates the baby may have a chromosomal abnormality
  • Have had a previous pregnancy affected with a disorder
  • Have one or more relatives affected with a genetic disorder
Both are ultrasound guided procedures and should be performed by trained operators and special expertise in not only performing but also counseling about the tests and their results (usually, therefore, a specialist in Fetal Medicine). The procedures should be performed under strict aseptic conditions and continuous ultrasound visualisation of the needle-tip whilst the procedure is in progress.

The major differences in the two Procedures are given below

  CVS Amniocentesis
What does it involve? Taking a small amount of placenta under ultrasound guidance. Taking a small amount of amniotic fluid that surrounds the baby in the womb under ultrasound guidance.
When is the safest time to have the procedure? After 11 weeks of pregnancy. After 15 weeks of pregnancy.
What is the risk of miscarriage? About 1 in 100 (1%) women will miscarry as a result of the procedure. About 1 in a 100 (1 %) women will miscarry as a result of the procedure.
What is involved in ending the pregnancy? At this stage, this involves a small operation (D&C) to empty your womb. Ending a pregnancy later on may involve going into labour (second trimester MTP).
There are two types of laboratory test which can be used to look at the baby's chromosomes. These are:
  • A full karyotype which checks all the baby's chromosomes. Results from this test are usually ready within two to three weeks
  • A rapid test (FISH) which checks for specific chromosomes. The disorders that can be detected by the rapid test include Down syndrome (known as 'trisomy 21' caused by an additional chromosome 21), Edward syndrome (known as 'trisomy 18' caused by an additional chromosome 18) and Patau syndrome (known as 'trisomy 13' caused by an additional chromosome 13) and if requested sex chromosome disorders. Results from this test are usually available after three working days.

Intra-uterine Fetal Blood Transfusions

This is a highly specialised procedure wherein the fetus is given a transfusion of cells whilst still inside the uterus. It is required when the condition of the fetus is critical (severe anemia) and the fetus is too premature to be delivered (usually less than 34 weeks). It is encountered when the mother is of a Rhesus negative blood group and her husband is Rhesus positive and they have conceived a Rhesus positive fetus. Sometimes, fetal anemia can result from an infection called as parvovirus infection, which is not always noticed by the mother (i.e. she may feel completely normal or may have a passing mild temperature and rash). However, this virus passes onto the fetus and destroys its red blood cells leading to anemia.

There are risks to the intra-uterine transfusions, hence they are usually performed only when absolutely essential and should be performed by experts in this technique.

Embryo Reduction / Selective Fetocide

Embryo reduction is a procedure that is performed in multi-fetal (more than three) pregnancies with separate placentae (it is vital to check for this). It is performed to avoid the risks of severe prematurity when three or more fetuses are conceived. Usually, this happens due to Assisted reproduction (IVF or IUI) techniques, though some spontaneous cases do arise. This procedure is performed in order to reduce the risks of prematurity and the resulting physical and mental handicap risk to the surviving babies in the long term.

However, there are risks with losing the entire pregnancy (up to 10%) due to this procedure, hence, it has to be discussed very carefully. It is recommended that this procedure is performed by an experienced person as it has to be done without causing harm to the other fetuses that are left to survive.

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