Fetal medicine

What is it in children?

Fetal medicine is the care of babies before birth. Fetal medicine specialists are obstetricians: they diagnose problems in the womb, and some conditions, such as spina bifida and congenital diaphragmatic hernia, can be treated before birth ^[1].

Paediatric surgeons are part of the team. They counsel parents before birth about a condition that will need surgery afterwards, then operate after the baby is born ^{[2, 3]}. Fetal surgery for spina bifida in the UK is done by a team that includes fetal surgeons, obstetricians and neurosurgeons ^[4].

Typical conditions and operations

• Prenatal diagnosis of a congenital anomaly that needs surgery after birth, planned in a multidisciplinary team ^[3].
• Antenatal counselling by paediatric surgeons, part of their neonatal training ^[2].
• Spina bifida, which can be repaired in the womb ^{[1, 4]}.
• Congenital diaphragmatic hernia, one of the conditions that can respond to treatment before birth ^[1].

How to get there

There are two ways into this work. To become a fetal medicine specialist, you train in obstetrics and gynaecology. To be the surgeon who counsels parents and operates after birth, you train in paediatric surgery ^{[1, 2]}.

1. 5 to 6 yearsMedical school

   A medical degree. To apply for the Foundation Programme you need to be eligible for provisional registration with the GMC ^[5].

2. 2 yearsFoundation Programme

   The two-year UK Foundation Programme ^[5].

3. Choose your route

   Which part of the team do you want to be?

   • 7 yearsObstetrics and gynaecology

     A run-through programme with an indicative length of seven years. In the last three years you do either two Special Interest Training Modules, such as Fetal Care, or a full subspecialty programme ^[1].

   • CT1 to ST8Paediatric surgery

     Core surgical training, then paediatric surgery from ST3, which includes prenatal counselling. See neonatal surgery for the full pathway ^[2].

4. ST5 to ST7Maternal and fetal medicine subspecialty training

   For obstetricians: three years of subspecialty training that replace the last three years of O&G training, after a competitive interview ^[1].

Good to know

• Maternal and fetal medicine subspecialty trainees are expected to plan care with paediatric specialists, including surgeons, and observing neonatal surgery counts as evidence ^[1].
• When it launched, the UK fetal surgery programme for spina bifida was a partnership between Great Ormond Street, UCLH and University Hospitals Leuven ^[4].

Getting involved as a student

• BUSOG, the British Undergraduate Society of Obstetrics and Gynaecology, is a national society for medical students and foundation doctors, with a network of ambassadors ^[6].
• The RCOG has membership options for anyone considering O&G, and lists awards and prizes for medical students ^[6].
• BAPS student membership costs £25, if the surgical side is what interests you ^[7].