By Mona Fawzy
I’m a Consultant Obstetrician and Gynaecologist with a special interest in foetal maternal medicine. Maternal medicine involves looking after pregnant patients with a range of medical conditions such as epilepsy, heart disease, HIV, diabetes and other endocrine problems. It also involves looking after patients who have had complications in the last pregnancy that led to a poor outcome. Foetal medicine, on the other hand, deals with foetuses diagnosed on ultrasound scan with congenital abnormalities or pregnancies that have been exposed to teratogens. For example, viral infections (Zika virus and CMV), drugs and radiation. It also involves prenatal genetic diagnoses. This is done by taking a sample of amniotic fluid from around the baby (amniocentesis) or sampling the placenta (chorionic villous sampling).
My clinical activities involve labour ward cover, which includes being a member of the on-call team. As a team, we review patients in or being induced for labour and prioritise their management according to the degree of urgency. During the shift, we do caesarean-sections, instrumental deliveries and manage emergency obstetric scenarios. For the whole team to function well, we all receive simulated multi-disciplinary training every year.
The on-call team will also be responsible for patients presenting to labour ward triage with obstetric emergencies. They will review patients referred by the community midwife to the antenatal day-unit, as well as managing high-risk obstetric patients on the antenatal and post-natal wards.
In my antenatal clinic, I meet my new pregnant patients and review their medical history, do a risk assessment and formulate a provisional plan for the pregnancy. This will include communicating with medical and surgical teams, as well as the GP to ensure multi-disciplinary care. During the journey of pregnancy, this plan will have to change to adapt to the dynamic changes happening.
I also enjoy being a part of our joint endocrine clinic where we look after patients with endocrine disorders, for example, diabetes. I run this clinic with a consultant endocrinologist, diabetes nurse and a specialist midwife for diabetes in pregnancy. There is an ongoing national audit for diabetes in pregnancy which monitors and compares the service provided by each maternity unit in the UK and it is rewarding to see our service doing very well.
I also have a foetal clinic where I perform ultrasound scans and look after foetuses with congenital problems, such as spina bifida and heart disease. It involves referring couples with foetuses that have complex abnormalities that will require immediate intervention after delivery at a tertiary unit. Foetal medicine is a rapidly evolving science that allows your skills to flourish, through research in interventional ultrasound, genetics and intra-uterine foetal surgery.
Additionally, I do a pre-conceptional clinic which involves counselling patients who have had previous poor outcomes and planning for their future pregnancies.
I love my speciality and if I could go back in time, I would choose it again. It is extremely rewarding when a pregnancy has a safe outcome for both mother and baby and to see the patient’s happiness when they first hold their child. This is especially true for when the pregnancy has been difficult with complex medical problems that required interventions and intensive monitoring throughout the pregnancy. It’s always lovely to receive a picture of these babies, updating me on how they’re doing. I feel over the moon when patients choose to be booked under my care again because of the service provided during last pregnancy.
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