Taking Fetal Medicine to the Community

AbstractSupplementing prenatal care with ultrasound technology has a significant impact on improving maternal and perinatal health by identifying at-risk pregnancies and directing deliveries to hospital settings. Ectopic pregnancies, placenta praevia, multiple pregnancy, fetal malposition, and abnormal fetal growth are known to increase morbidity and mortality, and can be diagnosed using ultrasound. We are now able to predict complications in pregnancy as early as the 12th week. The routine use of fetal ultrasound and innovations in fetal therapy raise several moral dilemmas including the unequal distribution of supporting health care and nonavailability of these services to a large proportion of the population residing in developing countries. Several strategies are available to improve delivery of these services: central government provision, contracting out to the private sector and NGOs, decentralization to local governments and community participation. Focused training of fetal medicine specialists, midwives, nurses, and technicians and provision of supporting infrastructure can deliver results and possibly eliminate the disparities in health care.