Fetal Medicine: Insights for Clinicians

Preface
Contents
About the Authors
1: Introduction to Fetal Medicine
2: History Taking in the Fetal Medicine Clinic
2.1 At the First Antenatal Visit
3: Timeline of Fetal Evaluation in Normal Pregnancy
3.1 4–6 Weeks of Gestation
3.2 6–11 Weeks of Gestation
3.3 11–14 Weeks of Gestation
3.4 14–16 Weeks of Gestation
3.5 16–18 Weeks of Gestation
3.6 18–20 Weeks of Gestation
3.7 20–28 Weeks of Gestation
3.8 28–32 Weeks of Gestation
3.9 32–40 Weeks of Gestation
3.10 Beyond 40 Weeks of Gestation
4: Principles and Methods of Screening for Fetal Aneuploidies
4.1 What Is Screening?
4.2 The Concept of “Intermediate Risk”
4.3 Which Pregnant Woman Should Be Offered Screening for Fetal Aneuploidies?
4.4 Which Are the Tests Available for Screening for Fetal Aneuploidies?
4.5 First Trimester Combined Screening Test
4.6 Second Trimester Maternal Serum Biochemistry (Quadruple Test)
4.7 Cell-Free Fetal DNA Test
4.8 The Midtrimester Genetic Sonogram
Suggested Reading
5: Basics of Imaging for Fetal Evaluation
5.1 Fetal MRI
5.2 Safety of Ultrasound
5.3 Some Good Practice Points
5.4 Ethical Considerations
6: Evaluation of Fetal Biometry
6.1 Ultrasound Biometry in Early Pregnancy
6.2 Significance of Early Pregnancy Biometry
6.3 “Dating Is a New Beginning!!”
6.4 Fetal Biometry in Second and Third Trimester
6.5 Biparietal Diameter
6.6 Head Circumference
6.7 Abdominal Circumference
6.8 Measurement of Fetal Femur Length
6.9 Calculation of Estimated Fetal Weight on Ultrasound
6.10 Supplementary Biometry: The Transcerebellar Diameter
Suggested Reading
7: Midtrimester Fetal Anomaly Scan
7.1 Prerequisites to Performing a Fetal Anomaly Scan
7.2 Fetal Number and Viability
7.3 Orientation of the Fetus (Assessment of Situs)
7.4 Fetal Anatomy Assessment
7.4.1 Fetal Skull
7.4.2 Fetal Brain
7.4.3 Fetal Face
7.4.4 Fetal Neck
7.4.5 Fetal Thorax
7.4.6 Fetal Heart
7.4.7 Fetal Abdomen
7.4.8 Fetal Spine
7.4.9 Fetal Limbs
7.4.10 Genitalia
7.4.11 Other Parameters Assessed at the MTAS
7.5 Scope of the Midtrimester Anomaly Scan
7.6 Planning Further Care After Detecting Fetal Anomaly
Suggested Reading
8: Basics of Doppler Imaging and Application in Fetal Medicine
8.1 Fetal Circulation
8.2 Umbilical Artery Doppler
8.3 Fetal Middle Cerebral Artery Doppler
8.4 Fetal Ductus Venosus Doppler
8.5 Uterine Artery Doppler
8.6 Safety Issues with Fetal Doppler
Suggested Reading
9: Fetal Growth Disorders
9.1 Fetal Growth Restriction
9.1.1 Etiology and Classification of Fetal Growth Restriction
9.1.2 Diagnosis and Evaluation of Fetal Growth Restriction
9.1.3 Management of Fetal Growth Restriction
9.2 Fetal Overgrowth Conditions
Suggested Reading
10: The “First Trimester (11–14 Weeks) Scan”
10.1 Reconfirmation of Fetal Viability and Dating
10.2 Detailed Fetal Structural Assessment at the 11–14 Weeks’ Scan
10.3 Screening for Spina Bifida by IT (Intracranial Translucency)
10.4 Markers for Fetal Aneuploidy Screening in the  11–14 Weeks’ Scan
10.4.1 Fetal NT
10.4.2 Fetal Nasal Bone
10.4.3 Tricuspid Blood Flow
10.4.4 Ductus Venosus Blood Flow
10.5 Basic Workup of Multifetal Pregnancy at the 11–14-Week Scan
10.6 Evaluation of Uterine Artery Doppler in First Trimester Scan
10.7 Evaluation of Maternal Cervix in First Trimester Scan
Suggested Reading
11: Multiple Pregnancy Evaluation in Fetal Medicine Clinic
11.1 Establishing the Diagnosis and Chorionicity of Multifetal Pregnancy
11.2 Dating of a Multifetal Pregnancy
11.3 Systematic Labeling of Fetuses in Multifetal Gestation
11.4 Aneuploidy Screening in Multifetal Pregnancy
11.5 Screening for Fetal Anomalies in Multifetal Pregnancy
11.6 Planning a Rational Follow-up for Serial Monitoring of Multiple Pregnancy
11.6.1 DICHORIONIC DIAMNIOTIC Twins
11.6.2 MONOCHORIONIC DIAMNIOTIC Twins
11.7 Twin Reversed Arterial Perfusion (TRAP) Sequence
11.8 Monochorionic Monoamniotic (MCMA) Twins
11.8.1 Conjoined Twins
11.9 Higher-Order Multiples (Triplets, Quadruplets, and So on)
Suggested Reading
12: Placenta, Cord, Amniotic Fluid, and Cervix
12.1 Evaluation of the Placenta in Pregnancy
12.2 Placenta in Second Trimester
12.3 Location and Edges
12.4 Size
12.5 Morphology of the Placenta
12.6 Umbilical Cord Insertion
12.7 Assessment of Umbilical Cord Morphology
12.8 Single Umbilical Artery
12.9 Persistent Right Umbilical Vein
12.10 Amniotic Fluid
12.11 Assessment of Cervix
Suggested Reading
13: Basics of Genetics in Fetal Medicine
13.1 Fluorescence in Situ Hybridization (FISH)
13.2 Quantitative Fluorescent PCR (QfPCR)
13.3 Multiplex Ligation-Dependent Probe Amplification (MLPA)
13.4 Clinical Exome Sequencing (CEX)
13.5 Targeted Mutation Analysis
Suggested Reading
14: Recurrent Fetal Problems: Looking for Solutions
15: Invasive Prenatal Diagnostic and Therapeutic Procedures
15.1 Indication
15.2 Pretest Counseling
15.3 Rhesus Status Check
15.4 Maternal HIV and Hepatitis B Screening
15.5 Consent
15.6 Amniocentesis
15.7 Chorionic Villus Sampling (CVS)
15.8 Fetal Blood Sampling
15.9 Invasive Prenatal Threapeutic Procedures
16: Rhesus Isoimmunization and Fetal Infections
16.1 Rhesus Isoimmunization
16.2 Fetal Infections
Suggested Reading
17: Potential for Assessing Maternal Morbidity in Fetal Medicine Clinics
17.1 Uterine Artery Doppler Studies Predict Risk of Preeclampsia
17.2 Hyperglycemia in Pregnancy
17.3 Maternal Autoimmune Diseases
Suggested Reading
18: Essentials of Counseling in Fetal Medicine
18.1 Pretest Counseling
18.2 Pretest Counseling for Fetal Scans
18.3 Posttest Counseling for Fetal Scans
18.4 Pretest Counseling for Fetal Screening Tests