What Fetal Medicine Means in My Practice
In fetal medicine I look after your baby as a patient in its own right. Most of that work is done with ultrasound, supported by genetic tests, counselling and, now and then, treatment given before birth.
The majority of pregnancies need only a handful of scans, provided each one is done at the right week. What makes them useful is good timing, reading the result in the light of your own history, and leaving the room with a clear next step.
Alongside the FNB, my NT-scan accreditation comes from the Fetal Medicine Foundation (UK), and I trained in 3D ultrasound and maternal-fetal medicine at Fernandez Hospital, Hyderabad. I perform and report the scans myself. So the person who explains a finding to you is the person who saw it on the screen. This keeps the discussion focused on your baby rather than on a printed report.
Fetal Medicine Doctor: What the Role Involves
A fetal medicine doctor looks after the unborn baby: an obstetrician who has trained further in ultrasound, prenatal diagnosis and the complications that affect a baby before birth. The work sits between routine antenatal care and the paediatric teams who care for the baby after birth. In practice I do four things:
- Screeningat the key weeks of pregnancy.
- Investigatingan abnormal screening result or something seen on a scan.
- Monitoringbabies who are at higher risk.
- Planningthe birth, or treatment of the baby before birth.
About 2–3 babies in every 100 have a significant structural or genetic condition, and most of them are born to parents with no known risk factor. This is why screening is offered in every pregnancy, not only in those labelled high-risk.
Sonography in Pregnancy Week Wise: When Each Scan Is Due
For most women, this means three or four sonography visits in the whole pregnancy. The extra scans in the table are added only when there is a specific reason.
| Scan | When | What I look at |
|---|---|---|
| Dating and viability scan | 6–9 weeks | That the pregnancy is inside the uterus, the heartbeat, the dates and the number of babies |
| NT scan with combined screening | 11 weeks to 13 weeks 6 days | Chance of chromosomal conditions, early anatomy, risk of pre-eclampsia, and chorionicity in twins |
| Level II anomaly scan | 18–22 weeks | Detailed structure of the baby, the placenta and the fluid |
| Fetal echocardiography | Around 18–24 weeks, when indicated | A focused study of the baby's heart |
| Growth and Doppler scans | From 28 weeks, as needed | Size, fluid, and blood flow in the cord and the baby's brain |
| Cervical length scan | 16–24 weeks, when indicated | The risk of preterm birth |
| Twin surveillance | Every 2–4 weeks from 16 weeks | Growth and complications specific to twins |
If a window is missed - the NT window in particular - some information is lost and cannot be recovered at a later scan.
Screening Versus Diagnostic Testing for the Baby
Screening tests - the combined first-trimester test and the cell-free DNA blood test (NIPT) - give a probability, such as 1 in 1,000 or 1 in 50. They carry no procedure-related risk to the pregnancy, but they are not a diagnosis.
Diagnostic tests - CVS and amniocentesis - study the baby's own cells or genetic material. For the conditions they test, they give a definite answer, but the procedure itself carries a small risk.
Whether you have a test, which one, or none at all is your personal decision, taken after counselling. A low-chance result is reassuring, though it cannot cover everything. A high-chance result is a reason to talk things through - it is not a diagnosis.
Who I Suggest a Fetal Medicine Consultation For
- A higher-chance result on the NT scan, blood screening or NIPT.
- A structural finding or a soft marker on any scan.
- An earlier baby with a structural, chromosomal or genetic condition.
- Thalassaemia trait or another known genetic condition in either partner.
- Consanguinity - a close blood relationship between the partners.
- Diabetes from before pregnancy, epilepsy medicines or other exposures that can affect the baby's development.
- Twins or more, especially when the babies share a placenta.
- An Rh-negative mother with antibodies, or a previous baby who was small or stillborn.
If Your Scan Shows a Finding
When I see something on a scan, I tell you what it is and how sure I am. I explain what it may mean for your baby and what choices you have. These may be a repeat scan, a more focused scan such as a fetal echo, a genetic test, or simply watching over time. I often draw the anatomy on paper so that you can explain it to your family at home.
You will have time to think and to ask questions, and you get written reports in case you want a second opinion. Indian law sets time limits on some pregnancy decisions, so scans and follow-up visits need to happen on time.
If the finding may be genetic, we talk about what extra testing would add and whether it would change the plan. We also discuss what it could mean for brothers and sisters and for future pregnancies. Some parents want every detail; others prefer to concentrate on caring for the baby. I respect both choices.
Checking the Baby's Wellbeing in the Third Trimester
In the last part of pregnancy my attention moves from structure to wellbeing. A growth scan measures the head, abdomen and thigh bone to estimate the baby's weight, and Doppler studies the blood flow in the umbilical artery and the middle cerebral artery.
Each kind of result leads to a different plan. Growth below the 10th centile, too much or too little fluid, or an abnormal Doppler may mean a repeat scan in two weeks, or frequent monitoring and an early delivery. Fewer baby movements always need an assessment on the same day.
These scans are not routine for every woman. I plan them for a reason - high blood pressure, diabetes, a previous small baby, twins, or a bump that measures larger or smaller than expected.
Planning the Birth Around a Diagnosed Condition
When a condition has been diagnosed before birth, the timing, place and mode of delivery can be organised around what the baby will need. Some heart, kidney, bowel or spine conditions call for a paediatric surgeon or cardiologist, or delivery at a specialised centre.
For many findings, birth at Divine Women's Hospital is appropriate: obstetric and neonatal staff are available there 24×7, and the baby can be seen by a paediatrician soon after birth. A few conditions, such as severe anaemia in the baby, can be treated before birth - this is described on my fetal therapy and IUT page.
Limits of Ultrasound You Should Know
- Ultrasound used for a medical reason by a trained operator, at the lowest exposure needed, is considered safe.
- No scan, however carefully done, picks up every condition.
- Some heart, brain or skeletal conditions only become visible later in pregnancy.
- Many genetic conditions, hearing loss and developmental conditions cannot be seen on ultrasound at all.
- Image quality depends on how the baby is lying, the mother's build, any scar tissue and the amount of fluid, so a repeat visit is sometimes needed.
- 3D ultrasound is useful in selected situations; it adds to the standard 2D scan but does not replace it.
The PCPNDT Act and Every Scan I Perform
Indian law under the PCPNDT Act forbids identifying a baby's sex before birth. Whatever the reason for your scan, the baby's sex is neither looked for nor told to you or your family.
What Happens at a Fetal Medicine Appointment, Step by Step
- BookingI time the scan to the week that will tell us the most, based on your dates and history.
- The scanI perform and report it myself, and I take responsibility for what happens next.
- Your resultsexplained at the same visit in Gujarati, Hindi or English, with a written report.
- Next stepsfurther scans, genetic counselling, CVS or amniocentesis are arranged and explained to you before any decision is made.
- Birth planningif a condition is confirmed, the delivery is planned in advance with the obstetric and neonatal teams.
Good Reasons to Book a Fetal Medicine Scan
- Your NT scan or anomaly scan is due.
- A screening test has shown a higher chance.
- A scan done elsewhere has shown something that needs a second look.
- An earlier baby had a structural or genetic condition.
- Either partner has thalassaemia trait, or the two of you are related by blood.
- You have diabetes, are expecting twins, or there is congenital heart disease in the family.
Pregnancy Symptoms That Need a Same-Day Check
- Fewer or no baby movements after 24 weeks.
- Vaginal bleeding at any stage.
- Fluid leaking from the vagina.
- Severe or constant pain in the abdomen.
- An abdomen that is enlarging quickly, with breathlessness - especially with twins.
Hospital staff at Divine Women's Hospital are on duty 24×7 for these situations; phone +91 90545 74829 while you are on the way.
Pregnancy Scan Beliefs Versus Facts
| Belief | Fact |
|---|---|
| "Scans harm the baby, so the fewer the better." | Diagnostic ultrasound at the recommended weeks is considered safe. Skipping the key scans means losing information that matters. |
| "A normal NT scan means the baby is completely healthy." | A normal NT is reassuring, but the anomaly scan at 18–22 weeks looks at the baby's structure in far more detail. |
| "3D and 4D scans are more accurate than routine scans." | Diagnosis is made on the standard 2D scan. 3D adds detail in selected cases only. |
| "Any finding on a scan means something serious." | Many findings are minor, temporary or simply normal variations. I explain each one in context before suggesting further tests. |
Questions Patients Ask Me About Pregnancy Scans
Can ultrasound scans harm my baby?
Ultrasound used for a medical reason by a trained operator, at the lowest exposure needed, is considered safe for the baby.
How many scans does a normal pregnancy need?
Three main scans - the dating scan, the NT scan and the anomaly scan. Growth scans are added only when there is a particular reason.
How is a fetal medicine specialist different from a gynaecologist?
Every obstetrician does routine pregnancy scans. A fetal medicine specialist has additional training in detailed ultrasound and in complications that affect the unborn baby.
Should I come with a full bladder?
Sometimes, for an early scan. After the first trimester it is usually not needed. You will be told when you book.
Can a scan pick up every problem?
No. Many major structural problems are found, but some appear only later in pregnancy, and many genetic conditions cannot be seen on a scan.
What does a soft marker on my scan mean?
A soft marker is a minor finding that is common in healthy babies. It can change the chance of a chromosomal condition slightly, so I interpret it together with your screening results.
Can my husband or family come in for the scan?
Yes. It often helps to hear the explanation together.
Can you look at a scan that was done somewhere else?
Yes. Bring the report and the images, and I can do a review scan at the same visit.
What should I bring to a fetal medicine appointment?
Your earlier scan and test reports, screening reports, blood group, any reports from previous pregnancies or genetic tests, and a list of the medicines you take.
Does the PCPNDT Act apply to my scans?
Yes, to every one of them. Under the PCPNDT Act the baby's sex is not identified or revealed at any scan I perform.