Diploma in fetal medicine | FMF fellowships | Welcome to the Fetal Medicine Foundation

– diagnostic testing

The indications, risks and techniques of amniocentesis, chorion villus sampling and cordocentesis.

– fetal development

Embryology, including normal and abnormal development of major systems. Teratogenicity, including mechanisms and agents.

– fetal malformations

Ultrasound features, prenatal and postnatal management, and prognosis for abnormalities of the brain and spinal cord, face, heart and great arteries, lungs, diaphragm, gastrointestinal and urogenital tracts, abdominal wall and skeletal system. Chromosomal defects, including epidemiology, implications and prenatal screening by ultrasound, serum biochemistry and analysis of cell-free DNA in maternal blood.

– fetal therapy

Animal models, medical treatment (transplacental and fetal), intrauterine surgery (open, laparoscopic and ultrasound-guided). Pathophysiology, assessment and management of red cell isoimmunization, alloimmune thrombocytopenia, monochorionic twins, diaphragmatic hernia, fetal hydrops and obstructive uropathy.

– genetics

Modes of inheritance, syndromology, molecular genetics and gene therapy, cytogenetics (conventional and molecular), pre-implantation diagnosis, genetic counselling.

– impaired placentation

Fetal growth restriction, preeclampsia and fetal loss. Pathophysiology, implications, screening, prevention, diagnosis, assessment and management.

– implications for the individual and society

Ethics, law, psychology, sociology, politics, economics.

– infections

Toxoplasmosis, cytomegalovirus, rubella, human immunodeficiency virus, hepatitis, varicella, Coxsackie, Parvovirus B19, Listeria. Pathophysiology, implications, screening, prevention, diagnosis, assessment and management.

– maternal and fetal physiology

Maternal physiological adaptation to pregnancy, including cardiovascular, respiratory, renal, endocrinological, hematological and nutritional changes. Placental physiology in normal and pathological pregnancy, including developmental anatomy and structure, metabolic and endocrine function, and transfer.

Amniotic fluid, including origin, composition and regulation. Fetal physiology in normal and pathological pregnancy, including fetal biochemistry, hematology, endocrinology and immunology, regulation of acid-base balance, fetal behavior and biophysical profile.

– medical disorders

Diabetes mellitus, autoimmune disease including systemic lupus erythematosus and antiphospholipid antibodies, cardiovascular, pulmonary, renal, hepatic, hematological, neoplastic disorders. Pathophysiology, implications, screening, prevention, diagnosis, assessment and management.

– multiple pregnancy

Epidemiology, pathophysiology, chorionicity, discordancy for defects, growth or death, twin-to-twin transfusion syndrome, prenatal diagnosis, assessment and monitoring, multifetal pregnancy reduction.

– neonatology

Basic assessment and resuscitation, intensive care, ventilation and nutrition, growth retardation, macrosomia, infection, brain hemorrhage, periventricular leukomalacia, enterocolitis, survival and handicap, prediction of handicap.

– perinatal pathology

Perinatal death and placental pathological examination. Use of MRI and minimally invasive post-mortem examination.

– preterm delivery

Uterine activity (to include anatomy, physiology, molecular biology), pathophysiology, implications, screening, prevention, diagnosis, assessment and management.

– research methodology

Medical statistics and epidemiology. Undertaking a literature search and summarizing the findings, planning a research project, writing an application for a grant-giving body and research ethics committee, computerization, statistical analysis and interpretation of data and writing an audit report, scientific papers and a thesis.

Application for obtaining the diploma in fetal medicine

Please send your curriculum vitae, logbook and letter of recommendation from the director of training to fellowship@my-sertif.ru.

It is important that before you apply you have obtained all the FMF certificates of competence.

Fmf accredited practitioners

Health care professionals who have who have completed or are still engaged in training fellowships in Fetal Medicine.

Measurement of biomarkers

• Technique for measurement of mean arterial pressure: please click here.
• Technique for measurement of uterine artery PI: please

  UTPI can be measured by either transabdominal or transvaginal sonography.

  Transabdominal scan in the first trimester

  Transabdominal scan in the second or third trimester

  Transvaginal scan in any trimester

  After identification of each uterine artery

  click here.

• Measurement of biochemical markers requires validated equipment and reagents. At present these are provided by DelfiaXpress from PerkinElmer, Kryptor from ThermoFisher and Elecsys from Roche.
• All measurements for biophysical and biochemical markers are expressed as multiples of the normal median (MoMs), adjusting for maternal factors that provide substantive contribution to their value. This application allows calculation of MoMs from the measurements of biomarkers. In the case of biochemical markers you may prefer to record the MoM values obtained from your laboratory.

References

1. Tan MY, Syngelaki A, Poon LC, Rolnik DL, O’Gorman N, Delgado JL, Akolekar R, Konstantinidou L, Tsavdaridou M, Galeva S, Ajdacka U, Molina FS, Persico N, Jani JC, Plasencia W, Greco E, Papaioannou G, Wright A, Wright D, Nicolaides KH. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Ultrasound Obstet Gynecol 2021; 52: 186-195.
2. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2021; 377: 613-622.
3. Litwinska M, Syngelaki A, Wright A, Wright D, Nicolaides KH. Management of pregnancies after combined screening for pre-eclampsia at 19-24 weeks’ gestation. Ultrasound Obstet Gynecol. 2021; 52: 365-372.
4. Panaitescu A, Ciobanu A, Syngelaki A, Wright A, Wright D, Nicolaides KH. Screening for preeclampsia at 35–37 weeks’ gestation. Ultrasound Obstet Gynecol 2021; 52: 501-506.

Required knowledge

The candidates should have a good knowledge and understanding of the following:

Requirements

The Diploma in Fetal Medicine will be awarded to candidates who have successfully undertaken specialist theoretical and practical training in a recognized fetal-maternal center for a minimum of 2 years.

The trainees will need to complete a log-book to demonstrate the range of conditions managed and they will be required to obtain a recommendation from the program director of the center in which they received training.

Screening for pe at 19-25 weeks 3

Screening at this stage should ideally be by a combination of maternal factors, uterine artery PI, mean arterial pressure and serum PLGF and the risk for PE <32 weeks and PE <36 weeks should be calculated. On the basis of these risks the women are stratified into high-, intermediate- and low-risk management groups.

The high-risk group would require close monitoring for high blood pressure and proteinuria at 24-31 weeks. The intermediate-risk group together with the undelivered pregnancies from the high-risk group, would have reassessment of risk for PE at 32 weeks to identify those that would require close monitoring for high blood pressure and proteinuria at 32-35 weeks.

• At risk cut-off of 1 in 25 for PE <32 weeks, 1% of the population would be stratified into the high-risk group which will contain nearly all cases that will develop PE at <32 weeks; these patients need close monitoring at 24-31 weeks.
• At risk cut-off of 1 in 150 for PE <36 weeks, 10% of the population would be stratified into the intermediate-risk group which will contain about 90% of cases that will develop PE at 32-36 weeks; these patients need reassessment at 32 weeks.
• All pregnancies would have reassessment of risk for PE at 35-37 weeks to define the high-risk group for term-PE.

Screening for pe at 30-35 weeks

Screening at this stage should ideally be by a combination of maternal factors, uterine artery PI, mean arterial pressure, serum PLGF and serum sFLT-1.

• At risk cut-off of 1 in 150 for PE <36 weeks, 10% of the population would be stratified into the high-risk group which will contain nearly all cases that will develop PE at 32-36 weeks; these patients need close monitoring for high blood pressure and proteinuria at 32-35 weeks.
• All pregnancies would have reassessment of risk for PE at 35-37 weeks to define the high-risk group for term-PE.

Screening for pe at 35-38 weeks 4

Screening at this stage should ideally be by a combination of maternal factors, mean arterial pressure, PLGF and sFLT-1.

• At risk cut-off for PE at <42 weeks of 1 in 30 the detection rate of term-PE is 75% at SPR of 13%. The rationale for such late third-trimester screening is identification of a high-risk group that would benefit from close monitoring to minimize adverse perinatal events for those that develop PE by determining the appropriate time and place for delivery.

Training

The practical component of the Diploma in fetal medicine is a full-time structured training program designed to cover the diagnosis and management of the whole spectrum of fetal disorders and pregnancy complications.

Candidates will be expected to acquire a high standard of competence in the clinical management of high-risk pregnancies; ultrasound diagnosis and management of fetal anatomical and functional abnormalities; Doppler assessment of the uterine and fetal circulations; amniocentesis, chorion villus sampling and cordocentesis.

The International Educational Committee will consider applications for accreditation from departments of fetal-maternal medicine with active research programs and a clinical workload that is sufficiently broad for the trainee to be exposed to most fetal conditions and techniques for fetal diagnosis and therapy.

Узи 11-13 недель –
fmf курсы

Audit of results

To ensure that the service you provide is of high quality it is important that you audit the distribution of your mean arterial pressure and uterine artery PI measurements and MoM values of PAPP-A, PLGF and sFLT-1 at regular intervals.

The median MoM value for each biomarker should be approximately 1.0 MoM. The audit function will highlight whether your values are outside acceptable limits:

• In the case of mean arterial pressure and uterine artery PI, you may need to retrain in taking appropriate measurements.
• In the case of biochemical markers, you should review the process of collection and transportation of samples to the laboratory and whether the laboratory uses the appropriate software and adjustments in the calculation of MoMs.

To use the application please click here.