Time of India
04 May 2010
By Risha Chitlangia

From Diagnosis To Surgical Interventions, Foetal Medicine Has Come A Long Way
When they look at their twoyear–old daughter Avika playing with other children, Prashant and Harshita can’t help but thank god. Doctors had asked Harshita to terminate her pregnancy in the eighteenth week because the foetus 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,” said Prashant, who had consulted several doctors. Each had the same thing to say, except for Anita Kaul, senior consultant, foetal medicine at Indraprastha Apollo. “She was the only one who ruled out any serious complication, giving us the confidence to go ahead,” said Prashant. The tumour in Avika’s lung dissolved on its own soon after birth and now she doesn’t have any 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 Anita Kaul. But foetal medicine experts said there is a lack of awareness about this branch of super–specialty medicine among the people and even doctors.

Foetal medicine can be divided into two main branches: diagnostic and therapy. A detailed foetal scan will pick up structural and chromosomal anomalies, which would otherwise have been missed. “Regular scans often miss heart defects. We screen a foetus from head to toe. We can pick up Down’s syndrome; certain types of mental retardation after studying family history; thalassaemia major; genetic disorders etc,” said Vandana Chaddha, consultant, centre for foetal and genetic medicine, Moolchand Medcity.

Till a decade ago, the focus of foetal medicine experts was diagnosis. But now, experts are able to perform complicated surgical interventions to save a foetus.

Deepika Deka, a gynaecologist at AIIMS, who started the foetal medicine unit in 1986, has performed close to 600 blood transfusions on foetuses. “If the mother is Rh–negative, her immune system treats Rh–positive foetal cells as foreign substances and makes antibodies against the foetal blood cells, lowering haemoglobin. Then we need to give O negative blood to the foetus 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 due to 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 to up chances of survival of the other baby,” said Chaddha. In some cases, one twin bleeds into the other. “Then, we need to cauterise the umbilical cord of the abnormal twin. Using foetoscopy, we enter the uterus from the abdomen and cauterise the umbilical cord,” said Deka.

Experts said women should come in for a scan in the early stages of their pregnancy. “We can pick up a foetal abnormality as early as the eleventh week,” said Dr Deka. Dr Kaul agreed, saying, “Any foetal intervention can start labour pain, so we need to be very careful. If a patient comes to us in the eighteenth week, we have little time to observe the foetus post surgical–intervention. We can’t abort a foetus after the twentieth week.”

Another key role experts play is in helping women complete a full term. “Doctors often prefer to deliver a baby before term as they’re worried about intra–uterine death. But that risks the baby’s growth. Premature babies suffer from neurological disabilities. We want babies to spend a maximum amount of time in the womb. Only by keeping a foetus under observation, we can help the baby,” said Dr Kaul.