Dr. Aditi Dubey, Fetal Medicine Specialist

A fetal medicine specialist diagnoses and manages conditions affecting the baby before birth. The work covers detailed ultrasound assessment of fetal growth and anatomy, screening for chromosomal and structural conditions, monitoring pregnancies affected by maternal illness, and planning care for babies found to have a condition. In most cases the specialist works alongside the treating obstetrician rather than replacing them.

The difference is additional subspecialty training focused on the fetus and on high-risk pregnancy. A gynaecologist or obstetrician manages routine pregnancy, delivery and general women’s health. A fetal medicine specialist has completed further training after that, usually in advanced ultrasound, prenatal diagnosis and the management of complicated pregnancies. A referral is made when a pregnancy needs that extra layer of assessment, and the two doctors then share the care.

Usually when a scan or test result needs a closer look, or when the pregnancy carries a known risk. Common reasons include an unclear or abnormal finding on a routine scan, a high-risk screening result, twins or triplets, a previous baby or family history of a birth condition, maternal diabetes, high blood pressure, thyroid or autoimmune disease, recurrent pregnancy loss, or concern about the baby’s growth. A referral is not a diagnosis. It is a step towards a clearer answer.

A pregnancy is called high risk when something about the mother, the baby or the pregnancy itself raises the chance of complications. On the mother’s side that includes diabetes, high blood pressure, heart, kidney, thyroid or autoimmune disease, obesity, age over 35, and previous pregnancy complications. On the baby’s side it includes poor growth, a structural difference, an abnormal screening result, or more than one baby. Most high-risk pregnancies still end well. The label means closer monitoring, not a poor outcome.

A recognised medical degree and a postgraduate qualification in obstetrics and gynaecology, followed by dedicated fetal medicine training. Beyond that, look for documented subspecialty work such as a fellowship or postgraduate programme in fetal medicine or fetal cardiology, and certification for the specific scans being offered, for example nuchal translucency or fetal echocardiography. Patients are entitled to ask which qualifications a doctor holds and where the training was completed.

Fetal cardiology is the diagnosis and management of the baby’s heart conditions before birth. It uses detailed ultrasound of the fetal heart to examine the chambers, valves, major vessels, rhythm and blood flow, and to identify congenital heart differences while the pregnancy is ongoing. Identifying a heart condition before birth allows the delivery to be planned at a hospital equipped to care for the baby from the first minutes of life.

Fetal echocardiography is usually performed between 18 and 24 weeks of pregnancy. It is commonly recommended when there is a family history of congenital heart disease, a previous child with a heart condition, maternal diabetes or certain autoimmune conditions, exposure to particular medicines, a pregnancy conceived through assisted reproduction, an irregular fetal heart rhythm, or anything unclear about the heart on the routine anomaly scan. Where risk is high, some centres also perform an earlier assessment in the first trimester.

The commonly recommended scans are the dating scan at about 6 to 8 weeks, the NT scan between 11 weeks and 13 weeks 6 days, the anomaly or TIFFA scan at about 18 to 22 weeks, and growth scans in the third trimester at roughly 28, 32 and 36 weeks. Doppler studies and fetal echocardiography are added where there is a specific indication rather than routinely. The exact schedule should be set by the treating doctor for the individual pregnancy.

The anomaly scan is a detailed ultrasound examination of the baby’s anatomy, usually performed between 18 and 22 weeks and sometimes up to 24 weeks. It systematically examines the brain, face, spine, heart, chest, abdominal organs, kidneys and limbs, along with the placenta, umbilical cord and amniotic fluid, and also checks growth. TIFFA stands for Targeted Imaging for Fetal Anomalies and refers to the same examination.

No. Under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994, no person conducting a prenatal procedure may communicate the sex of the fetus to the pregnant woman or her relatives by words, signs or any other method. All ultrasound clinics, genetic clinics and diagnostic laboratories must be registered under the Act. The law restricts disclosure of sex only. Every other part of prenatal diagnosis is unaffected by it.

Diagnostic ultrasound is considered safe in pregnancy when it is performed by a trained operator for a medical reason. It uses sound waves rather than ionising radiation, and operators are expected to use the lowest output and the shortest exposure that will answer the clinical question. Scans carried out purely for souvenir images, with no clinical indication, are not recommended.

No. A normal detailed scan is reassuring, but it cannot rule out every condition. Ultrasound detects many structural differences, yet some conditions develop later in pregnancy, some are too subtle to see, and metabolic, genetic, hearing and vision conditions may not show on imaging at all. Detection rates also vary with the stage of pregnancy, the baby’s position and the quality of the images obtainable. A good report states both what was seen and what could not be assessed.

The next step is usually a more detailed assessment rather than an immediate decision. That may involve a repeat or targeted scan, fetal echocardiography, genetic counselling, and in some cases a diagnostic test such as chorionic villus sampling or amniocentesis. Families are then told what the finding means, how it may be treated, and what the options are. Many findings turn out to be minor variations or resolve on their own before birth.

Very little preparation is needed for most scans. Early pregnancy scans may require a full bladder, while later scans usually do not. It helps to wear loose two-piece clothing, carry previous scan reports and blood test results, and allow extra time, because a detailed anomaly scan or a fetal echocardiogram takes considerably longer than a routine scan. Asking questions during the examination is entirely appropriate.