DOI: 10.1111/tog.

12549 2019;21:5–6
The Obstetrician & Gynaecologist
Editor's Pick
http://onlinetog.org

Spotlight on . . . fetal medicine

Surabhi Nanda MD MRCOG Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Correspondence: Surabhi Nanda. Email: [email protected]

Introduction Prenatal fetal surveillance

Since the introduction of obstetric ultrasound by Ian Donald in Modalities of optimal prenatal surveillance including the
1958, fetal medicine has continued to evolve from being solely biophysical profile, screening for growth restricted fetuses,
focussed on obstetric imaging to a more holistic subspecialty in the importance of fetal movement and the clinical
its contribution to perinatal care. Prof. Kilby’s article on application of fetal Doppler are covered over the years
prenatal diagnosis in the modern era beautifully illustrates this (TOG 1999;1:41–5; TOG 2009;11:245–51; TOG 2015;17:13–9).
evolution (TOG 2016;18:213–9). Indeed, the first issue of The article summarising the INTERGROWTH-21st project
The Obstetrician & Gynaecologist (TOG) in 1999 was visionary in would appeal to all obstetricians worldwide (TOG 2016;18:
covering topics like intrapartum fetal monitoring (TOG 1999;1: 137–41). The ideology behind prenatal fetal surveillance to
18–21) and in utero gene therapy (TOG 1999;1:37–8). These prevent stillbirths is beautifully summarised by Prof. Gordon
areas continue to evolve and are still topical, as evidenced in the Smith (TOG 2015;17:183–7).
Each Baby Counts campaign and recent developments in whole
genome sequencing and gene therapy, respectively.
Multiple pregnancy
Antenatal screening With the incidence of multiple pregnancy on the rise globally,
TOG has continued to provide readers with evidence-based
Chromosomal abnormalities reviews on topics ranging from a general overview on
Evolution of screening for common aneuploidies,
multiple pregnancy and controversies in management, (TOG
particularly Down syndrome, is succinctly covered by Prof.
2000;4:4–10; TOG 2010;12:179–85) to specific complications,
Nicolaides’ group (TOG 2019;21:51–7). The article by Lakhi
such as twin-to-twin transfusion syndrome (TOG 2006;8:
et al. (TOG 2012;14:267–73) provides the reader with
1–6), single twin demise (TOG 2002;4:17–20) and
practical guidance around management of a pregnancy
monoamniotic twins (TOG 2012;14:71–8). Mode of
complicated by abnormal serum analytes reported on first
delivery in twins is elegantly covered by Breeze and Smith
or second trimester screening. Prenatal screening is entering a
(TOG 2004;6:222–6). The article from Prof. Norman’s group
‘non-invasive’ era. Three papers covering the fundamentals
on preterm delivery in twins and the controversies in
of non-invasive prenatal testing, including the ethics in
prevention strategies in this high-risk group forms essential
testing and reporting, provide essential reading (TOG 2006;8:
reading for anyone looking after this high-risk population
91–5; TOG 2013;15:80–4; TOG 2017;19:211–8).
(TOG 2018;20:57–63).
Congenital anomalies
The article on the NHS Fetal Anomaly Screening Programme Preterm birth
(FASP) succinctly summarises the standards and
implementation of this programme (TOG 2011;13:211–7). Various fetal medicine centres across the globe are
Not all abnormalities are detected, and some may be incorporating a dedicated preterm birth surveillance clinic
incorrectly diagnosed; screening programmes are also likely in their practice. Some articles from leaders in this field that I
to be shrouded in ethical dilemmas. Dr Loughna illustrates would recommend cover prediction and diagnosis of cervical
the limitations and Dr Stewart the ethics of FASP very insufficiency (TOG 2008;10:99–106), management of
sensitively (TOG 2008;10:33–7; TOG 2004;6:104–7). extreme prematurity (TOG 2018;20:109–17), including the
However, once a diagnosis is made, the management is role of magnesium sulphate for neuroprotection (TOG
usually multidisciplinary, as beautifully illustrated in TOG 2017;19:21–8), and the clinical application of trans-
2013;15:189–94. abdominal cerclage (TOG 2016;18:117–25).

ª 2019 Royal College of Obstetricians and Gynaecologists 5

 Editor’s Pick

of modern ultrasound (TOG 2006;8:222–7) is essential

Congenital infections
reading. Lack of consensus on imaging in pregnancy has
There is a wide variation in routine screening for and prevalence been raised as a concern in various Confidential Enquiries
of congenital infections in pregnancy. I believe that the various into Maternal Deaths. Two TOG articles (TOG 2010;12:71–8
articles covering general management and common congenital and TOG 2010;12:171–7) succinctly cover common imaging
infections like cytomegalovirus and parvovirus B19 would modalities, biophysics and considerations relevant to safety
appeal to the global readership of TOG (TOG 2009;11:108–16; in pregnancy.
TOG 2009;11:96–100; TOG 2003;5:4–9).

Fetal medicine and other subspecialties

Fetal therapy
The complexity of pathology in pregnancy is on the rise, and
There are several recommended TOG articles that provide an
fetal medicine cannot remain a subspecialty in isolation. The
overview of fetal therapy, covering areas from management
cross-pollination with MRI (TOG 2006;8:71–7; TOG 2015;17:
of fetal anaemia and intrauterine transfusion (TOG 2003;5:
189–99) and clinical genetics (TOG 2002;4:64–9; TOG 2006;8:
15–20) to recent advances, including treatment of shared
171–6) are just a few examples. The effect of maternal disease
placentation by fetoscopic laser and management of
on the fetus is elegantly illustrated in TOG 2012;14:167–74.
congenital diaphragmatic hernia (TOG 2005;7:183–9; TOG
This is just a taste of the many articles on fetal medicine
2010;12:94–102).
that have appeared in TOG in the last 20 years. It is very
gratifying to see that TOG continues to keep its readers
Safety of diagnostic imaging updated on the advances in this fast evolving subspecialty.
In the post-Montgomery era, when communication of risks is An online collection of all TOG articles on fetal medicine is
a vital part of our practice, the excellent article on the safety available at onlinetog.org.

6 ª 2019 Royal College of Obstetricians and Gynaecologists