Fetal Medicine: Insights for Clinicians

Description

This book provides an overview of Fetal Medicine practice focusing on various aspects of fetal health such as screening for fetal aneuploidies and imaging for fetal anomalies, their basic management and technological breakthroughs.Although the field of Fetal Medicine is very wide, this book has condensed the important issues and is written in an " easy to read" format to simplify concepts for the readers.  Fetal Medicine has emerged as a separate specialization and has an interdisciplinary appeal for clinicians. With the advent of knowledge and awareness in this field there are emerging challenges in counseling patients regarding available options. This book aims to be a ready reference for clinicians in Obstetrics and Radiology who encounter patients with fetal anomalies, growth disorders, multiple pregnancies and genetic /chromosomal problems. This is a highly informative and carefully presented book providing insights for clinicians with an interest in Fetal Medicine 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