Maternal and Fetal medicine involves the prevention, diagnosis and treatment of those conditions responsible for the morbidity and mortality of the mother, fetus and the early newborn. The rapidly expanding body of knowledge regarding maternal health and disease, the continuing introduction of new technologic methods for maternal and fetal assessment and increasing societal demands and expectations for mother and child, continue to modify the nature of obstetrical care. A direct result of these evolving processes is a need for specialists in maternal-fetal medicine.
Training of the maternofetal medicine subspecialist:
The Feto-Maternal and perinatal subspecialist is a specialist in Obstetrics and Gynecology who has had a theoretical and practical training in
- Detailed risk assessment before, during and after pregnancy
- Antenatal diagnosis of the wide range of Materno-Fetal disorders, some of which may require an invasive procedure
- Management of very high risks pregnancies during the antenatal, intra-partum and post-partum period.
Aim of the training
To improve the care of pregnant women and fetuses at high risk, working in collaboration with other care providers.
Objectives of the training
To train a subspecialists to be capable of
- Improving knowledge, practice, teaching, research and auditing
- Co-ordinating and promoting collaboration in organising the service
- Providing leadership in development and research within the subspeciality
Organization of training
- Training programmes should be in a multidisciplinary center of Obstetrics and Gynecology and should be organised by a subspecialist or an accredited and subspecialist.
Centers should use the guidelines and protocols by national professional bodies and are reviewed at regular intervals.
Training as a subspecialist in feto-maternal medicine does not imply that the subspecialist cannot practice in the generalist field of Obstetrics and Gynecology.
The means of Training
- Entry Requirements
- MD/DNB in Obstetrics and Gynecology from an institute recognized by Indian Medical Council.
- Trainees should participate in all relevant activities of the training unit such as the care of out-patients and in-patients, on call duties during both day and night, performing ultrasound examinations and intra-uterine procedures and participating in educational activities, including the teaching of other health professionals. Participation in audit and clinical or basic research is essential.
- The duration of subspecialty training should
include a minimum of two years in an approved programme and should cover the
clinical and research aspects of the following areas:
- Ultrasound and other imaging procedures
- Maternal and Fetal Surveillance in high risk pregnancies
- Basic science e.g. maternal and fetal physiology, histo-pathology and embryology
- Training should be structured throughout with clearly defined targets to be met after specified intervals. An educational plan should be drawn up in consultation with the trainee at the beginning of each attachment and progress should be monitored regularly, by mean of the Log Book.
Assessment of training
Each student is evaluated every month by the programme coordinator.
The student gets the opportunity to evaluate the course
The Log Books are to be submitted monthly evaluation
The degree is awarded after a final exit examination, at the end of the two-year training period
Training Programme syllabus
Pharmacological effects of drugs in common use in obstetric practice, including details of metabolism, excretion and teratogenic effects
Pathology of diseases that occur during pregnancy, including pregnancy included hypertension, nephritis, thromboembolism, placental disease, amniotic fluid embolism, cardiac disease and infections. An understanding of the value and limitations of postmortem examination of the fetus or neonate
Details of known teratogens in human biology, including drugs and environmental agents
Medical and surgical complications
Special expertise in the commonly occurring associated with pregnancy, including diseases of the cardiopulmonary system, the digestive system, the nervous system, the immune system, the urogenital system and malignancies.
Special expertise in the diagnosis, prevention and management of all conditions affecting the mother and
Knowledge of the physics of ultrasound
To be conversant with and know the indications for – new imaging techniques such as CT scans and MRI
In addition to counseling skills for genetic disorders, expertise is required in preconception counseling for diabetes, previous preterm birth and other high risk obstetric and medical conditions
A working knowledge is required of the organizational responsibilities inherent in the practice of maternal fetal medicine at a subspecialty level. These responsibilities may include:
Creating protocols for management
Organization and co-ordination of clinical meetings
A substantial knowledge of the principles and practice of research is required
Experience is required in teaching at postgraduate levels in the field of Maternal-Fetal Medicine
Components of the Fellowship
- High Risk Obstetric and Ultrasound
- The trainee works in a clinical role which is responsible for the management of the maternal disorders and pregnancy complications which constitute high risk obstetric. It is expected that the trainee will receive instruction in and acquire the cognitive and technical skills for the full breadth if diagnostic and therapeutic procedures constituting maternal-fetal medicine. Developing an understanding of the practice of maternal -fetal medicine in an Indian environment is an important part of this programme. Trainees must also acquire special competence in diagnostic ultrasound where it relates to pregnancy. This training will include both diagnostic imaging and ultrasound guided interventional procedures. This time should provide the trainee with the opportunity to concentrate on the application of the ultrasound to the study of pregnancy. Trainees will receive additional ultrasound experience in clinical maternal-fetal medicine in both the procedural and diagnostic areas.
- Trainees are required to spend a minimum period in neonatology unit.
- Trainees are required to attend genetic clinics during the trainee period. Counseling for the full range of disorders relevant to the field of prenatal diagnosis should take place at these clinics.
- Research project (Thesis)
- The research project should be prospectively approved and demonstrate the basic principles of research – original hypothesis testing, research methodology, rigorous scientific method.
Specific objectives of the fellowship
It is expected that the subspecialist in Maternal Fetal Medicine will be able to demonstrate
- Knowledge of the basic sciences relevant to Maternal & Fetal Medicine
- A thorough knowledge of the pathophysiology, methods of evaluation and treatment of the maternal disorders and pregnancy complications contributing to high risk fetal and early newborn problems. A full knowledge and competence in all of the modalities of fetal diagnosis and therapy. State of the art skills and competence in the management of all acute and chronic problems within the discipline of maternal fetal medicine.
- An understanding of the concepts of investigate science and the development of skills in research methods
- An understanding of the organization of health services in the areas of Maternal Fetal Medicine
- Understanding of the methods of quality assurance and audit.
The practice of a Maternal Fetal Medicine subspecialist involves the following 4 major subgroups of patients
- A patient undergoing diagnostic procedures
- Patients with medical and surgical disorders
- Healthy pregnant women with fetuses with marked increased risk of adverse outcome
The study plan may be devised in consultation with the faculty / senior fellows/ head of the department
The academic activities in the hospital include
- The morning academic sessions
- The seminars and case discussions
- Paper presentations
- Audits / projects
- Conference / Workshops