Fetal medicine

What is the programme and its aims?
Fetal medicine is the speciality that encompasses any extra care required for babies in the womb, such as for smaller babies or babies with other complications. All maternity services provide some fetal medicine care, with some services providing more specialised care for mothers and babies with particularly complex or highly specialised needs. In order to provide the best care closest to home within the East Midlands we are approaching the provision of fetal medicine via the development of a virtual operational delivery network, which includes all trusts, to provide a comprehensive service, with placental laser treatment being the only specialised care that is not delivered in the area. Our aim is to engage clinicians and commissioners to maintain a sustainable East Midlands fetal medicine network that will improve services in accordance with national service standards, delivering care as close to home as possible.

Why is the programme required?
Fetal medicine has been separated from standard maternity care provision, and is provided to differing levels within different services. Recognising the importance of provision of these services to pregnant women, trusts within the East Midlands have universally agreed to the ongoing provision of these services whilst participating in a network arrangement to allow local expertise and care close to home. In addition, a networked delivery approach will allow effective pathways into and out of specialist services and ensure sustainable local services which fulfil specialised services specifications and meet the criteria for dedicated funding.

Who are the partners?
  • clinicians
  • clinical commissioning group commissioners
  • specialised commissioners

How are we making a difference?
In order to support and strengthen the fetal medicine network we have established a virtual multi-disciplinary team forum for discussion of complex case management and clinical support. This forum, which uses WebEx technology, will enable good communication and discussion of care plans between clinicians, reducing the need to travel for women requiring fetal medicine input and supporting local clinical experience and expertise. The fetal medicine network has also developed a regional pathway to enhance choices for women who wish to end a pregnancy in the face of a serious abnormality in the baby.

Pregnancy-associated plasma protein A (PAPP A) is a protein used in screening for Down syndrome in the first trimester. Recent guidelines on the assessment of the small (for gestational age) baby, has included this as a risk factor for poorer growth. We have worked to provide a pathway of care for women with this additional risk factor and we have finalised a regional pathway for management of women with a low of PAPP A. We launched many of our outcomes to stakeholders at a regional event in May 2016.

What’s next?
We are looking to agree an approach for fetal transfusion between local units and for babies with cardiac and renal anomolies. We also plan to facilitate a regional approach to placenta accreta. Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium (the muscular layer of the uterine wall). Because of abnormal attachment to the myometrium, placenta accreta is associated with an increased risk of heavy bleeding at the time of attempted vaginal delivery. The need for transfusion of blood products is frequent, and hysterectomy is sometimes required to control life-threatening hemorrhage.

Who to contact for further information?
This email address is being protected from spambots. You need JavaScript enabled to view it., Maternity and Children’s Quality Improvement Coordinator