The practice of fetal medicine has major implications not only for the individual family, but for the society as a whole. There are training programs for subspecialization in fetal-maternal medicine in the USA, UK, Australia and Canada. However, the number is limited and these programs are not designed to meet the increasing world-wide demand for specialists.

In introducing the Diploma in fetal medicine we aim to build on the existing specialization programs and raise training standards internationally.

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.

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. Such centers must be either within hospitals or affiliated to institutions with an obstetric service with high proportion of high-risk perinatal patients as well as neonatal intensive care, neonatal surgery, perinatal pathology and genetic services.

Required knowledge

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

- Fetal development

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

- Genetics

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

- 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.

- Diagnostic testing

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

- 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.

- 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.

- Perinatal pathology

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

- 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.

- Preterm delivery

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

- Impaired placentation

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

- 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.

- Infections

Toxoplasmosis, cytomegalovirus, rubella, human immunodeficiency virus, hepatitis, varicella, Coxsackie, Parvovirus B19, Listeria. 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.

- Implications for the individual and society

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

- 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.

- Organization and administration of fetal medicine service

Structured training, clinical protocols, consent forms, research versus audit in clinical practice, patient notes, counselling, computerization.

Application for obtaining the Diploma in fetal medicine

Please send your curriculum vitae, logbook and letter of recommendation from the director of training to education@fetalmedicine.org.

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