The Maternal and Fetal Medicine Department on Cloudnine now brings its signature mix of cutting-edge technology and world-class expertise to Mumbai. This specialised division of Cloudnine focuses on assessing the risk of and diagnosing congenital handicaps and defects in unborn babies and the subsequent management of the same.
While the vast majority of babies are normal, about 3-4% of babies may have abnormalities that may result in mental or physical handicap. However, all parents wish to have a normal and healthy baby. Indeed, the mission in maternity is to have healthy and happy mothers and babies! The Maternal and Fetal Medicine Department of Cloudnine is armed with an array of tools for the effective diagnosis of fetal anomalies and appropriate multidisciplinary management of high risk and complex pregnancies.
Maternal-fetal medicine specialists, also called perinatologists, are obstetricians who specialise in the diagnosis, treatment, and ongoing care of expectant mothers and unborn babies who may be at risk of developing specific health problems.
Perinatology services provided by maternal-fetal medicine experts include maternal and fetal medical care, monitoring, fetal ultrasound examinations, genetic counselling, state-of-the-art diagnostic tests, fetal wellbeing tests, fetal surgery and a host of other multidisciplinary tools.
The Maternal and Fetal Medicine Department on Cloudnine Malad comprises a team of highly experienced and dedicated maternal-fetal medicine consultants, specialists and radiologists. We provide comprehensive, compassionate and specialised services aligned to the highest international standards.
Twin Pregnancy Clinic
With advances in ultrasound technology, it is now possible to identify birth defects and to perform a fetal diagnosis before a pregnancy has reached 13 weeks. Fetal diagnosis is an effective tool for couples, offering them a valuable keyhole to the health of their baby. Early screening can also help to mitigate the risk of birth defects and other possible concerns.
The nuchal translucency ultrasound scan is typically carried out between the 11th and 13th weeks of pregnancy. The scan is usually performed transabdominally but is sometimes done transvaginally. The scan is conducted with the following objectives in mind.
Accurate pregnancy dating: This is particularly relevant for women who cannot recall the date of their last period, women who have an irregular menstrual cycle and women who have conceived while breastfeeding or soon after stopping the pill. This scan uses the size of the fetus as a measure to determine the expected date of delivery.
Chromosomal abnormality detection: On Cloudnine, we assign an individual risk score to every expectant mother, based on a variety of factors such as age, hormonal composition, fetal heartbeat, nuchal translucency thickness, fetal nasal bone structure and blood flow through the foetal heart and ductus venosus and foetal abnormalities. Couples who display a high risk score are offered comprehensive counselling sessions on Cloudnine, pointing the way forward.
Multiple pregnancy diagnosis: Approximately 2% of natural conceptions and 10% of assisted conceptions result in the formation of multiple embryos. Ultrasound scanning can determine how well a multiple pregnancy is developing, whether both babies are growing equally and whether both babies share a single placenta. The Twin Clinic on Cloudnine is equipped to effectively manage a range of high-risk pregnancy cases.
Major abnormality detection: Major abnormalities may be visible at an early stage in a pregnancy; a detailed anomaly scan in the 19th week is therefore essential.
Early pregnancy failure detection: Unfortunately, about 2% of fetuses do not make it to the nuchal scan, sometimes dying several weeks before without any warning or trigger. On Cloudnine, couples with early pregnancy failures are offered counselling and guidance with regard to subsequent steps to be taken.
Risk assessment: Fetal growth restriction and maternal pre-eclampsia are evaluated during the nuchal scan and an appropriate treatment plan is created, if required. Assessment of the uterine artery doppler can effectively spotlight the risk of these two critical conditions. If the risk is found to be high, low dose aspirin can be started right away, in turn, minimising complications during pregnancy.
Down’s syndrome detection: Down’s syndrome is caused by the presence of an extra chromosome in fetal cells (Trisomy 21). The nuchal translucency test can determine chromosomal integrity, and indicate the risk of Down’s syndrome and other chromosomal abnormalities like Trisomy 13 and Trisomy 18. The risk of Down’s syndrome is influenced by a variety of factors including maternal age, previous medical history, fetal heart rate, maternal hormonal composition and fetal nasal bone structure.
If the fetal anomaly scan presents a high score, you may be advised a small array of additional tests. The non-invasive prenatal screening test is a superlative screening option that can detect Down’s syndrome as well as other chromosomal abnormalities with remarkable precision, without the insertion of a needle into the pregnancy. The cell free fetal DNA is analysed from a maternal blood sample, giving a result for Down Syndrome that is 99% accurate.
However, it is limited by several factors and may not be suitable in all cases. If the test returns abnormal results, it is usually followed by an amniocentesis procedure.
Chorionic villous sampling (CVS) entails the extraction of a small sample of placental tissue, via a fine needle passed through an expectant mother’s abdomen. This test is usually performed between the 11th and 15th weeks of pregnancy. CVS is the most accurate way to find out whether a fetus bears chromosomal abnormalities. However, it carries a miscarriage risk of 1-3 per 1,000 cases. If CVS is proposed to you, you and your partner will be taken through a sequence of expert counselling sessions in order to arrive at a decision.
Amniocentesis is a test in which the fluid surrounding a fetus is sampled via a needle passed through an expectant mother’s abdomen. This test should only be performed after 15 complete weeks of gestation. However, it presents a risk of miscarriage, much like with CVS. An amniocentesis procedure should be opted for after careful consideration. On Cloudnine, we offer professional counselling and guidance to help you navigate difficult decisions and forge a path forward.
The second trimester is composed of a series of scans and screening tests.
The fetal anomaly scan is a highly specialised ultrasound procedure that is performed in two stages: an early anomaly scan at the 14-week mark and a detailed anomaly scan at the 18-week mark.
Early anomaly scan: This is offered to couples whose offspring carry a high risk of developing genetic anomalies. The scan paves the way for an early diagnosis and management plan. Couples who have previously conceived babies with birth defects are encouraged to opt for the early anomaly scan to rule out the recurrence of past conditions.
Detailed anomaly scan: The detailed anomaly scan assesses each part of the fetus and also determines the position of the placenta, the amount of amniotic fluid, and fetal growth. Special attention is paid to the brain, face, spine, heart, stomach, bowel, kidneys and limbs.
On Cloudnine, we also carry out a transvaginal scan in the second trimester to measure the length of the cervix. This is especially important in women who run a high risk of preterm delivery. This includes those with multiple pregnancies, prior preterm babies, abnormalities of the uterus or previous cervical surgery. Anomalies in the cervix can be set right with effective surgical and / or medical intervention.
The fetal echocardiography is a detailed and specialised examination of the fetal heart and arterial vessels. This scan is recommended for women with a family history of heart abnormalities and those with a history of diabetes. It is also advisable for women with an elevated nuchal translucency at the First trimester scan. This scan may be recommended by your doctor if the basic anomaly scan points to a concern regarding the fetal heart. This concern could be a structural anomaly or a rhythm abnormality. The echocardiography is usually scheduled between the 18th and 23rd weeks of pregnancy.
In some cases, a pregnancy failure may be governed by a genetic predisposition. It is important to identify genetic conditions that could give rise to a miscarriage so that the risk of recurrence is reduced.
Genetic counseling is a process through which guests at risk of an inherited genetic disorder are advised of the probability of developing or transmitting the condition. A roadmap is then laid out, outlining prevention and risk minimisation measures.
On Cloudnine, our expert maternal and fetal medicine team conducts a detailed genetic evaluation called pedigree charting on high-risk guests. This process is jointly performed by a clinical geneticist and a developmental paediatrician, who delve into a guest’s genetic history and prior miscarriages, to arrive at a precise diagnosis. Genetic counselling is usually followed by specific genetic tests that aim to highlight mutations and the likelihood of their appearance. These tests serve as predictive tools to determine recurrence risk. Genetic counselling facilitates prenatal diagnosis, around the 11th week of pregnancy.