very informative relative to maternal and fetal health

1. Maternal-Fetal Medicine for
Neonatologists

2. Hypothyroidism in Mothers:
• Neonates born to mothers with hypothyroidism due to auto-antibody
disease are at risk of thyrotoxicosis.
• Review with thyroid function tests at around 2 weeks of age is
recommended to assess thyroid status.
• Mothers with Graves' disease may pass thyrotrophin receptor
stimulating antibodies (TRAbs) transplacentally, leading to neonatal
hyperthyroidism.

3. Twin–Twin Transfusion Syndrome (TTTS):
• Diagnosis before 26 weeks carries a significant risk, including the
demise of one twin and brain damage in the surviving twin.
• Management options include serial amniodrainage and laser ablation
of anastomotic vessels, with laser ablation showing better outcomes.
• In laser ablation, a laser beam is used to seal off some of the blood
vessels in the placenta so that both babies receive a more equal supply
of blood.
• Monitoring the surviving twin for cerebral lesions is crucial after the
demise of one twin.

4. Preterm Membrane Rupture:
• Women with preterm membrane rupture are treated with oral
erythromycin.
• Approximately 50% may deliver within a week, necessitating
preparation for preterm delivery.
• Preterm premature rupture of membranes (PPROM) complicates ~2%
of pregnancies but is associated with 40% of preterm deliveries.

5. Prenatal Diagnosis of Fetal Disease:
• In the UK, screening involves a fetal anomaly ultrasound scan at 18–
20 weeks, supplemented by nuchal translucency scan and serum
marker estimation.
• Tests aim to detect conditions like Down syndrome, syphilis, HIV,
hepatitis B, and maternal blood group.
• Laboratory tests on maternal serum, including alpha-fetoprotein
(AFP), are used for screening and assessing pregnancy outcomes.

6. Diagnostic Tests for Fetal Abnormality:
• Chorionic villus sampling (CVS), performed between 11 and 13
weeks, is used to sample placental tissue.
• Amniocentesis, usually carried out at 15–20 weeks, obtains amniotic
fluid for chromosomal analysis.
• Percutaneous umbilical blood sampling of fetal blood allows special
cytogenetic and immunological tests.
• Free fetal DNA in the maternal circulation is a non-invasive potential
for genetic studies.

7. Maternal Conditions Affecting the Fetus:
• Epilepsy: Teratogenic effects of antiepileptic drugs, such as phenytoin
and valproate, are considered.
• Diabetes: Screening for diabetes in pregnancy is recommended, and
tight control is crucial to reduce the risk of congenital malformations.
• Thyroid Disease: Graves' disease and maternal hypothyroidism impact
pregnancy outcomes.
• Liver Disease: Cholestasis of pregnancy, acute fatty liver, and HELLP
syndrome require specific management.

8. Multiple Pregnancy:
• Dizygotic (DZ) and monozygotic (MZ) twins pose different risks, with
monoamniotic MZ twins having special considerations.
• Determination of the pattern of placentation is crucial for managing
twin pregnancies.
• Monitoring is essential, and twin pregnancies, particularly after the
demise of one twin, are at high risk.

9. Placental Insufficiency:
• Doppler ultrasound helps monitor fetal well-being, and absent or
reversed end-diastolic flow in the umbilical artery predicts adverse
outcomes.
• Fetal blood flow and specific patterns help distinguish between
placental insufficiency and other causes of fetal growth restriction.

10. Preterm Premature Rupture of Membranes
(PPROM):
• PPROM complicates ~2% of pregnancies but is associated with 40%
of preterm deliveries.
• Management involves careful monitoring, and oral erythromycin is
associated with delayed delivery.
• Risks of prematurity and chorioamnionitis are considered in the
management of PPROM.

11. Intrapartum Monitoring:
• Continuous cardiotocography (CTG) is recommended for high-risk
pregnancies.
• Fetal scalp pH estimation and umbilical cord pH sampling provide
additional information on fetal well-being during labor.
• Interpretation of CTG includes heart rate, variability, accelerations,
and decelerations, with various types of decelerations classified.

12. Conclusion
• Prenatal screening and diagnostic tests play a pivotal role in
identifying fetal abnormalities, allowing for informed decisions and
appropriate care.
• The management of conditions like Twin-Twin Transfusion Syndrome
(TTTS) and placental insufficiency requires specialized approaches to
mitigate risks to both twins and ensure optimal outcome