What does the FMU offer?
The Fetal Medicine Unit (FMU) at Saint Mary’s Hospital is made up of highly experienced fetal medicine consultants and specialist midwives. In addition there are other specialist doctors such as neonatologists, geneticists, paediatric surgeons, fetal cardiologists and neurosurgeons who offer counselling and will take over the care of babies with abnormalities after they are born. There are also fetal medicine subspecialty trainees and sometimes visiting medical students, midwives and neonatal nurses.
The Fetal Medicine Unit serves a maternity population of 50,000 within the North West Region and receives over 1,000 referrals per year. The unit is one of 12 fetal medicine centres across England that is supported by Specialist Service Commissioning as of April 2013.
There are regular joint and separate clinics with consultant and nurse specialist colleagues from paediatric surgery, paediatric neurosurgery, paediatric nephrology, paediatric cardiology, paediatric urology, clinical genetics, neonatology and intensive care. Almost all of these specialties are co-located at the Manchester University NHS Foundation Trust site, either in Saint Mary’s Hospital or at the Royal Manchester Children’s Hospital. This means that mothers and their babies are not separated whilst their babies receive the required care after birth.
Crucially, the FMU service also maintains communication with the referring clinicians and specialities.
In the Fetal Medicine Unit we see patients for various reasons and whilst under our care we offer several services including high risk screening, scanning, prenatal diagnosis and treatments.
Our consultant obstetricians are supported by specialist midwives and other specialist staff from Paediatrics, Cardiology, Urology, Genetics, Neonatology, Neonatal Surgery, Neurosurgery, ICU and Royal Manchester Children’s Hospital.
What do we do in our clinics?
In our FMU clinics, we:
- Assess women at added risk of fetal abnormality.
- Confirm diagnosis of fetal abnormality.
- Give detailed information about likely outcomes, which includes providing multi-disciplinary input.
- Inform women and families about the choices available. On-going psychological support and counselling is provided by the Fetal Medicine Midwives.
- Provide women with a named midwife in Fetal Medicine.
- Initiate ongoing monitoring of pregnancies, where appropriate.
- Undertake interventional and therapeutic procedures, such as fetal blood transfusion.
- Assess possible complications in multiple births.
The service includes screening for, diagnosis of and treatment (where relevant) of:
- Chromosome abnormalities.
- Fetal anomalies.
- Single gene genetic diseases.
- Haemolytic disease of the newborn.
- Complex multiple pregnancies.
- Fetal growth restriction.
Communication with referring clinicians and other specialties is a crucial part of the work of the FMU service, with this being formally assessed in both CNST (NHSLA) and Specialist Commissioning evaluations of service effectiveness.
Different are the different types of clinics?
We have general clinics daily throughout the week. Here you will be seen by one of our highly qualified consultants and specialist midwives. During the appointment you will be scanned followed by counselling about the diagnosis, outlook and further management.
We also have a number of specialist clinics for:
- Complex Multiple Pregnancy
- Fetal Neurology
- Fetal Cardiology
- Paediatric Surgery
What procedures do you do?
Depending on the outcome of your scan, you may be offered one of the following procedures within our clinic:
The most common reason to have an amniocentesis is to determine whether a baby has certain genetic disorders or a chromosomal abnormality, such as Down syndrome, sickle cell anaemia or muscular dystrophy. This might be due to high risk from a screening test, fetal anomaly that might be caused by a genetic or chromosomal abnormality, past history of having a baby with a chromosomal abnormality or you and/or your partner have or are carriers of a genetic condition with increased risk of your baby inheriting this condition from you.
If you have been offered this test it does not mean that your baby definitely has any of these conditions. It just means you are at a higher risk of having one of these conditions. By doing the test it will give us more information about the health of your baby.
This test is usually carried out after 15 weeks of pregnancy.
During the procedure, a needle will be used to extract a sample of amniotic fluid. Amniotic fluid contains cells shed from the fetus that can be examined and tested for a number of conditions.
Before the procedure we will talk you through the possible complications and risks associated with amniocentesis. There is a 1% risk of miscarriage.
The final decision whether or not to have this test is up to you. And we will support you through any concerns you may have.
Chronic Villus Sampling (CVS)
The test involves removing and testing a small sample of tissue from the placenta. The placenta is the organ that links the mother’s blood supply with her unborn baby’s. A needle is inserted through the abdomen (tummy) or occasionally through the cervix (neck of the womb). The placenta has tiny fingerlike projections called chorionic villi and this is where the sample is taken from. The villus sample is sent to the cytogenetic laboratory where different techniques such as karyotype, QF-PCR and chromosomal microarray are used to show any possible abnormalities.
CVS is offered when it has been suggested that there is a high risk of the baby having such conditions. This could be because:
- An earlier antenatal screening test (such as the combined screening test for Down’s syndrome) has shown that you are at an increased risk.
- You have had a previous pregnancy with these problems, such as a baby born with a chromosome abnormality.
- You and/or your partner have or are carriers of a genetic condition such as cystic fibrosis, sickle cell anaemia or muscular dystrophy and there is an increased risk of the condition in this pregnancy.
- Your baby has an anomaly that can be caused by chromosomal or genetic abnormalities.
CVS is usually carried out between 11-14 weeks of pregnancy. The main advantage of CVS over amniocentesis is that you can have it done earlier. The main risk is that of miscarriage, which is about 1-2%.
Once this test has been recommended to you, you have the final decision on whether you would like to go ahead with CVS or not. We will support you in making a decision and addressing any concerns you may have.
Intrauterine transfusion (IUT)
In IUT the baby is given a blood transfusion while still in the womb. An intrauterine fetal blood transfusion requires specialist training and is only available in a few hospitals such as Saint Mary’s Hospital.
IUT involves inserting a needle through the mother’s abdomen (tummy) and into the umbilical cord so that donated blood can be injected into the baby. An ultrasound scanner is used to help guide the needle to the right place. Local anaesthetic is used to numb the area, but you will be awake during the procedure.
You may need more than one intrauterine fetal blood transfusion. Transfusions can be repeated every two to four weeks until your baby is mature enough to be delivered. IUT may even reduce the need for other treatments (phototherapy) after birth, but further blood transfusions could still be necessary.
There is a small risk of miscarriage and fetal death during an IUT, so it is usually only done in particularly severe cases.
Understandably this can be a very overwhelming time and we will be here to support you and your baby every step of the way.
- Dr Philip Bullen - Consultant Obstetrician and Subspecialist in Fetal and Maternal Medicine
- Dr Koon Loong Chan - Consultant Obstetrician and Subspecialist in Fetal and Maternal Medicine
- Dr Chibuike Iruloh - Consultant Obstetrician, Subspecialist Maternal and Fetal Medicine
- Dr Sorin Juverdeanu - Consultant Obstetrician
- Dr Gillian Stephen - Consultant Obstetrician