Fortunately, most of the pregnancies are normal and uncomplicated. But any pregnancy can run into complications. The complications that can affect a pregnancy can be baby specific or mother specific. Most of these complications can be predicted at a very early stage, some of them as early as in 1^st 3 months of pregnancy. Many of them are either completely or partially avoidable or treatable before or after the baby is born.

The most common types of complications are explained below.

1. Chromosomal and Genetic problems: Chromosomes and genes form the building blocks of all human beings. Any defect in these may lead to serious problems in structure and function of different body systems. Although few women are at an increased risk of having these problems, they can possibly affect any given pregnancy. It is very important to predict and diagnose chromosomal and genetic problems at the earliest because these may lead to severe defects in the baby. These problems are not correctable or treatable and there is a risk of recurrence of these problems in subsequent pregnancies. NT scan done between 12-14 weeks of pregnancy is the best time to screen for most of these problems. Babies found to be at a high risk for such problems may be subjected to special test in order to diagnose these serious problems at the earliest.
2. Structural anomalies: In about 2-3% of pregnancies, there may be problem in formation of different parts and organs of the baby. Some of these problems may be very serious and even incompatible with life while others may be mild and amenable to treatment either before or after the baby is born. About 40% of such problems can be diagnosed at the time of NT scan and remaining 50-55% can be diagnosed at the time of anomaly scan which is done between 18-24 weeks. About 5% problems may not be detected before birth. Some of these problems may require attention immediately after birth. If diagnosed beforehand, the fetal medicine specialist will guide the expectant couple and their doctor in order to plan the time and place of the delivery so that the baby can be attended to and treated without any delay.
3. Growth related problems: Some babies may not be able to reach their full growth potential or may not be able to gain enough weight inside the womb as the conditions inside may not be conducive. If such a problem is not detected on time, these babies may get compromised and sometimes even succumb if the problem is very severe. Most of these problems can be predicted at the time of NT scan and can be prevented to some extent with the help of medications. Pregnancies at a higher risk for developing such a problem may be monitored closelySo, a fetal medicine specialist here will help in 1^st predicting the risk for such a problem at a very early stage in pregnancy and then monitor the baby’s growth closely in order to identify such problems at the earliest. This is done to optimize the time and place of delivery in order to get such babies out at the right time where they can be better managed and given a fighting chance.
4. Multiple pregnancies: Sometimes there can be 2 or more babies inside the womb. Such pregnancies are called as multiple pregnancies. There is a specific type of Twin pregnancy in which both babies share a single placenta. They are called as identical or monochorionic twins. In such a situation, there are chances that they may receive inequal nutrition and then both babies may land into problems. Such problems can be predicted during early stages of pregnancy. When diagnosed in time, there are various specialised types of in utero (when babies are still inside the womb) treatments available for ensuring well-being of babies and the mother.

An expectant couple must visit a fetal medicine consultant for following reasons

1. Viability scan or Dating scan: Thisscan is performed during 1^st 2 months of pregnancy. This is done to confirm your gestational age of the pregnancy and its location. Sometimes pregnancies may be located outside the uterus. Such pregnancies are called as ectopic pregnancies. Such pregnancies must be diagnosed and treated at the earliest to avoid serious complications. Other issues in mother’s pelvis may also be diagnosed during these scans which may then be tackled at the earliest.
2. NT scan: This is one of the most important scans done between 12-13+6 weeks of pregnancy. Its objectives are accurately deciding gestational age of the pregnancy, assessment of structural problems in the baby, screening the baby for chromosomal and genetic abnormalities, assessing the risk of development of high blood pressure during the pregnancy and finally to assess the risk of preterm delivery i.e., delivery before completing full term. Hence, we now call it an ‘Advanced First Trimester Scan (AFTS)’. So, it’s pretty evident that to perform a NT scan in such detail is a timely affair and requires a whole lot of dedication and expertise. This scan is accompanied by detailed counselling for any of the above conditions and further investigations and course of action will be then discussed.
3. Anomaly scan: This scan is performed between 18-24 weeks of pregnancy. The main objective of this scan is to assess all the structures and organs of the baby in detail to rule out major structural problems. About 90-95% problems can be diagnosed while the baby is still inside the womb. Some problems may not be detected antenatally owing to their inconspicuous nature or solely because they present late.On encountering any issue, the couple is thoroughly counselled about it and all possible outcomes and management options are the discussed with the couple.
4. Fetal Echocardiography: This is a scan performed to study the fetal heart in detail and is preferably performed between 22-24 weeks (This is done in addition to detailed fetal heart evaluation performed at the time of anomaly scan). This scan is indicated in pregnancies that are at a higher risk for having fetal heart problems, for example babies with increased NT in first trimester, mothers having previous baby with heart problem, maternal heart problems, maternal diabetes, etc.
5. Fetal Growth and Well being scan: This scan is generally performed after 26-28 weeks of pregnancy. This is done to see whether the baby is gaining adequate weight, receiving enough nutrition and oxygen and having sufficient amount of amniotic fluid around. In cases where the baby is failing to grow well, has altered blood supply or decreased amniotic fluid, closer monitoring the recommended which will help in delivering the baby at the right time and at the right place before it gets compromised inside the womb. Such babies can then be managed by expert neonatologists.
6. Monitoring multiple pregnancies: Multiple pregnancies with 2 or more babies are more prone to develop complications. Such pregnancies require a close follow up in order to predict the possibility of a complication and diagnose and manage them on time. Especially cases of Monochorionic twin pregnancies must be monitored with utmost care as they are at a very high risk of running into complications. They must be monitored with ultrasound every 2 weekly beyond 16 weeks until the babies are delivered.
7. Antenatal interventions: These are special procedures that are performed while the baby is still inside the womb. They are majorly divided into two categories
   1. Diagnostic procedures: They are done in cases where risk of having chromosomal or genetic problems is higher as observed during NT scan or anomaly scan or based on certain blood tests or previous history. Such pregnancies can be then subjected to either Chorionic villus sampling (CVS) or amniocentesis which acquire baby’s cells which can be then directly tested to confirm or rule out a suspected problem.

CVS is the procedure that is performed between 11-14 weeks of pregnancy. In this procedure, some tissue sample from the placenta is acquired with the help of a needle.

Amniocentesis is performed after 16 weeks of gestation in which amniotic fluid sample is obtained with the help of a needle.

Both of these are invasive procedures and are associated with a negligible risk of miscarriage of around 0.2% in expert hands.

1. Therapeutic procedures: These are specialised procedures that are performed for specific problems that can be treated while the baby is still inside the womb. They include intrathecal methotrexate injection in certain types of ectopic pregnancies, laser ablation for chorioangioma, amnio-drainage for polyhydramnios, amnioinfusion for unexplained oligohydramnios, fetal blood transfusion in cases of fetal anemia, selective or elective fetal reduction for higher order multiple pregnancies (more than 2 babies at the same time) or multiple pregnancies with one abnormal baby, pleuro-amniotic or vesico-amniotic shunts, etc. Therapeutic procedures are also performed for management of complicated Monochorionic twin pregnancies, which include fetoscopic laser ablation for TTTS and interstitial laser or RF ablation.

You can book a prior appointment for your scan with a fetal medicine specialist. Have proper food before going to the clinic and carry something to munch on to the clinic. Remember, we are investigating an unborn baby who cannot communicate directly with us. Neither can we directly examine the baby as it is inside the womb. So,it’s extremely important to scan the baby in utmost detail to find out if there is any problem. During the scan, the baby may be in any position, looking up, looking down turned towards one side, etc. So, we may have to wait till the baby comes in a favourable position for us to examine all the organs in detail. These scans may be sometimes be time consuming and may take   longer than expected. This is the issue specially during NT scan, anomaly scan and fetal echocardiography. So, avoid having any other appointments on the day of your scan and keep your entire day reserved for your little one.  Because inside a fetal medicine clinic, “babies are the bosses” and they surely teach us a whole lot of patience.