Introduction to Fetal Medicine BIOL 6505 Introduction to - - PowerPoint PPT Presentation

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Introduction to Fetal Medicine BIOL 6505 Introduction to - - PowerPoint PPT Presentation

Feb 22, 2024 515 likes •857 views

Introduction to Fetal Medicine BIOL 6505 Introduction to Introduction in Fetal Medicine What is fetal medicine? Relevance of the course Why so early in curriculum? Paradigm for multidisciplinary R/ Touches many specialties

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Introduction to Fetal Medicine

BIOL 6505

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BIOL 6505 – Introduction to fetal medicine

Introduction

to Introduction in Fetal Medicine

  • What is fetal medicine?

 Relevance of the course

 Why so early in curriculum?  Paradigm for multidisciplinary R/  Touches many specialties

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BIOL 6505 – Introduction to fetal medicine

  • Course material

 Syllabus  References  Slides, images

 www.fetal-program.org

 (Attend MADAM conferences)

Introduction

to Introduction in Fetal Medicine

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BIOL 6505 – Introduction to fetal medicine

Introduction to fetal medicine 1/30 Friday Rm 275 Ethics of fetal medicine Genetics and fetal medicine 2/6 Friday Rm 275 Embryology Fetal diagnosis and imaging

  • a. MRI
  • b. Ultrasound

2/13 Friday Rm 275 Twin gestations Urological anomalies 2/18 Wednesday Rm 275 4:30-6:00 Pulmonary anomalies 2/20 Wednesday Rm 275 Visceral anomalies Neurological anomalies 2/25 Friday Rm 270 Hematological anomalies Cardiovascular anomalies 2/27 Friday Rm 275 Fetal surgery

Curriculum

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BIOL 6505 – Introduction to fetal medicine

  • Evaluation

 Attendance & participation  Questions-of-the-week  Exam:

 Mock MADAM conference

Wednesday 3/6, Rm 275

Introduction

to Introduction in Fetal Medicine

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The way it used to be

???

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The way it used to be

 Medicine of pregnancy (obstetrics)

 “Black box:” no prenatal diagnosis  Pregnancy, not fetus, is central  Treat newborn/infant/child

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The fetus as a patient

 Fetal diseases

 Autopsies/perinatal pathology  Newborns  Animal models

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The fetus as a patient

 Fetal physiology

 Animal models (fetal lamb)  Prenatal diagnosis (U/S, 1960s)

–Observation/ normal vs. abnormal –Opportunity to treat the fetus

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The fetus as a patient

 Premature infant: 23-36 weeks

 Neonatologist  Medical specialists

– Cardiologist – Endocrinologist – Geneticist – Nephrologist

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The fetus as a patient

 Premature infant: 23-36 weeks

 Neonatologist  Surgical specialists

– Pediatric surgeon – Pediatric urologist – Pediatric neurosurgeon – Pediatric orthopedic surgeon

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The fetus as a patient

 Fetus: 16-36 weeks

 Obstetrician  Maternal-Fetal Medicine specialist  No different than premature infant?

–Same multidisciplinary approach

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Fetal medicine vs. Obstetrics

 Obstetrics

 Mother, pregnancy and delivery

 Maternal-Fetal Medicine (MFM)

 High-risk pregnancies (diabetes)  Focus on mother and fetus  Only one person

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Fetal medicine vs. Obstetrics

 Fetal medicine

 Only fraction of high risk pregnancies  Fetus-, not pregnancy-directed  Multidisciplinary team

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Who needs fetal medicine?

 Multiple consultants

 MFM  Neonatologist  Surgeon  Geneticist  Radiologist  Endocrinologist

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

Obstetrician

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

Obstetrician MFM

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

Obstetrician MFM Pediatric surgeon Pediatric urologist Geneticist Cardiologist Neonatologist

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Who needs fetal medicine?
  • 1. Multiple consultants

 All talk to each other  All listen to each other  Develop a unified recommendation

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

Obstetrician MFM Pediatric surgeon Pediatric urologist Geneticist Cardiologist Neonatologist Fetal Program Coordinator

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Who needs fetal medicine?
  • 2. Need for intervention

 Prenatal intervention

–Alter mode/place/time of delivery –Invasive fetal procedure

 Perinatal intervention

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Who needs fetal medicine?
  • 3. Need for specific expertise

 Nobody can know everything  Difficult to remain up-to-date

–Changing trends –Evidence-based medicine

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BIOL 6505 – Introduction to fetal medicine

19th SEASON

Introduction to Fetal Medicine

  • The MADAM concept

Multidisciplinary Antenatal Diagnosis And Management

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • The MADAM concept

 Developed at Brown 1996  Other models exist (obviously!)  Meets twice-a-month  Discusses selected cases/patients

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Who is worthy of MADAM?
  • 1. More than one consultant involved
  • 2. Fetal management will be altered

Fetal surgical intervention, e.g.

  • 3. Protocol will likely be altered

Illustrative case

Develop evidence-based guidelines

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Altering the protocol:

 Gastroschisis – old teaching:

 Exposure to amniotic fluid is harmful

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

Gestational age (weeks)

Age at definitive closure

38 39 40 37 34 35 36 33 1 week

Huang J et al, Brown Fetal Medicine Program Obstet Gynecol 2002

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Altering the protocol:

 Gastroschisis – new teaching:

 Full term is best  No early delivery

 No need to discuss every gastroschisis

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Roles of MADAM:

 ‘Tumor board’ for fetal cases  Establish protocols  Educate others  Educate each other  Ethics board for novel therapies

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

  • Your role at a mock MADAM:

 Assume the identity of a specialist  Learn about a ‘patient’  Become an expert in your field  Discuss your point of view  Come to a consensus

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BIOL 6505 – Introduction to fetal medicine

Introduction to Fetal Medicine

 www.fetal-program.org  Questions-of-the-week  Next session: Friday 2/6 at 3:00

 Genetics  Embryology