Foetal medicine: saving lives in high-risk pregnancies

Dr Mokgadi Nchinyani recently joined Mediclinic Limpopo as a foetal medicine specialist, offering much-needed expertise to patients in the area.

Every expectant mother hopes for a comfortable, straightforward pregnancy, culminating in the birth of a healthy baby. Unfortunately, this isn’t always the case – which is why the job of the foetal medicine specialist is such an important one.

Dr Mokgadi Nchinyani, a foetal medicine specialist at Mediclinic Limpopo, says this is exactly why she was drawn to the specialisation. “We are able to make an enormous difference in mothers’ lives by treating conditions that may become problematic during their pregnancy,’” she explains. “Perhaps more importantly, in cases where we have identified issues that may affect the health and wellbeing of their unborn child, we’re able to provide options that help them cope during a difficult time.”

A patient will be referred to a foetal medicine specialist if her obstetrician has observed a condition that may place her at risk, such as an auto-immune disease, thyroid issues, advanced maternal age, a poor obstetric history or a background history of a genetic disorder, Dr Nchinyani explains. The mother may also be advised to consult a specialist if there are warning signs for pre-term labour or pre-eclampsia, both of which affect both mortality and morbidity.

On the other hand, it may be the growing foetus that needs extra care: the foetal medicine specialist may have been requested to screen for chromosomal or structural abnormalities during the first or second trimester, while third-trimester screening can help identify problems that present later on, such as bowel obstructions.

Each patient receives an individual care plan based on the particulars of their case. For example, says Dr Nchinyani, the treatment of a woman who has struggled to fall pregnant and now faces difficulties because of her own health issues will be very different from that of a mother who may pass on a genetic condition to her baby. “One thing all patients have in common, though, is that they deserve all of our empathy and compassion,” she says.

Multidisciplinary input

Dr Nchinyani adds that the complexity of each case requires input from a multidisciplinary team that may include:

• A maternal medicine specialist to monitor any developing or existing health conditions the mother may have.
• An obstetrician who helps plan the delivery of the baby.
• A paediatric surgeon neonatologist, who is on hand to assess the baby immediately after birth and develop a plan for treatment, if necessary.
• A genetic counsellor, if the mother already knows her child may be affected by a genetic condition. This counsellor can offer information about the condition and direct her towards a support group.
• Other specialists may also be involved; for example, a paediatric cardiologist may be asked to attend the birth if the baby has a heart condition; or a paediatric nephrologist if the kidneys are at risk.

Dr Nchinyani points out that by working together, the team is able to plan for potential complications – which can help to save the life of both mother and baby. “For example, if we’ve determined that a baby has a cardiac lesion, and we know what kind of lesion it is; we can plan accordingly. We’ll know if surgery is needed, and what type. This will dictate where the baby is born, because we may need a facility that is able to provide the appropriate services. If we’re aware of the treatment the baby may need, we may be able to prevent morbidity.”

First-trimester screening

For this reason, Dr Nchinyani recommends screening – in fact, she maintains that it should be the right of every woman to undergo screening during the first trimester. “If a pregnancy is going to have a poor outcome, we need to know so we can give the mother choices. In contrast, if you find out about issues that may affect the baby’s quality of life later in the pregnancy, those choices become more limited.”

She is quick to stress, however, that not every case that’s referred to a foetal medicine specialist for screening ends in termination. “It’s very important that mothers realise this,” Dr Nchinyani emphasises. “Screening doesn’t mean your child has a disease. It simply means we are equipping ourselves with information about your baby – so that, if there are any issues, we can identify them and start treatment as soon as possible.”

Her final message? “Don’t be afraid if you’re advised to consult a foetal medicine specialist. It’s simply to ensure the ultimate wellbeing of both you and your baby.”