Fetal Maternal Medicine is a rapidly progressing sub specialty in Obstetrics and Gynaecology worldwide. It focuses on the surveillance and management of high risk pregnancies especially those complicated by the structural or chromosomal fetal abnormalities or with medical disorders in pregnancy. Fellowship in Fetal Maternal Medicine, the first ever formal training programme in Pakistan was launched in 2008 at the Aga Khan University Hospital Karachi. This unique two year programme offers extensive experience in the clinical management of high-risk obstetric patients as well as formal training and excellent mentorship in clinical and research activities.
This fellowship programme aims to:
• Enable a fellow to become proficient in prenatal diagnosis (level III obstetric scans), antenatal care and management of complicated pregnancies.
• Support protected research that can be divided over two years as best accommodates any formal research training.
• Enhance the educational experience through didactic sessions, seminars, courses and lectures.
Supervising faculty will include fetal and maternal medicine faculty and other obstetricians involved in the care of complicated obstetric cases.
The medically complicated pregnancy is an emphasis during the first year of the fellowship. The first year fellow has two half day/week in fetal and maternal medicine outpatient clinics. An attending fetal-maternal specialist will manages the content of the clinic and serves as a mentor. During clinical rotations, fellow spends two half days per week in the prenatal diagnosis clinic. Each week they see patients referred secondary to being at risk for or suspected to have an anomalous fetus. The fellow is responsible for counseling the patient about the significance of any findings, developing a management plan for the remainder of the pregnancy, performing level III screening ultrasounds, and observing prenatal diagnostic procedures (amniocentesis and chorionic villus sampling) that are necessary. The fellows are supervised by one of the fetal medicine faculty.
The major emphasis will be on achieving advance competency level in management of complicated obstetrics cases and research activities. The fellow will be conducting independent fetal maternal medicine clinics, and performing level three fetal scans. Training will include a three months rotation at the secondary care centres of AKU to conduct fetal screening programs and maternal medicine clinics.
The fellow will be encouraged to enroll in formal training courses in epidemiology and biostatistics as well as designing and conducting research studies under faculty supervision. Publication of at least two original articles in an indexed journal on fetal-maternal medicine related topics will be a requirement of fellowship completion.
Objectives at the end of each year
The fellow will complete a period of at least 2 years of combined high risk obstetrics and level III obstetric ultrasounds
Fellow will work in a clinical role acquiring competency in cognitive and technical skills related to the diagnosis and management of complicated obstetric cases and fetal medicine screening procedures.
The first year is structured as an integrative experience. Fellow will attend rounds on admitted high risk obstetric cases and conduct supervised maternal medicine and fetal medicine clinics. There will be rotations in various medical specialty clinics and critical care areas such as ICU, NICU etc. according to a structured schedule. During the first six months the fellow will perform fetal medicine scans under direct supervision of the faculty and will be doing screening ultrasounds such as nuchal translucency independently. Two half day slots per week will be reserved for education and development of research. This time is used to explore both basic science and clinical research opportunities. Fellows will be strongly encouraged to pursue formal training courses in research methods already available at the University.
• Advance level competence in clinical and research activities at tertiary as well as secondary health care level.
• Advanced competence in diagnosis and management of high risk obstetric cases; able to function independently as fetal maternal medicine specialists.
• Conduct independent Fetal-maternal medicine clinics in secondary care centers of AKU with timely referrals to AKU when required
• Advanced competence in research methods, including grant writing, designing and conducting independent research project; must have at least two papers accepted for publication.
• Fellows will be strongly encouraged to pursue formal training courses in research methods already available at the University,
• Fellows will be encouraged to attend short courses in their specialisation.
Evaluation of fellows
During the training period the trainee will be expected to keep a log of the work done. Update the records as necessary. Continuous assessment will be carried out by all faculty members involved in high risk obstetrics. There will be two monthly appraisals with the supervisor to review log book and assessment of progress of the trainee.
Written evaluation by supervising faculty every two months
Six monthly written and oral assessment and feedback is done by programme director
Assessment tests at the end of courses attended
Development of study proposal by end of first year
Acceptance of two research papers for publication by end of second year
The programme offers a two-year fellowship. Training format as stated above.
• MBBS or Equivalent registered by PMDC
• One year House Job with at least six months in Obstetrics & Gynaecology
• Completed the CPSP recognised residency programme in Obstetrics and Gynaecology
• FCPS or MRCOG or Equivalent in Obstetrics and Gynaecology
One to two fellows will be taken each year.
Dr. Shama Munim Director Fetal-Maternal Medicine Fellowship Programme
Dr. Jahan Ara Pal Fetal Medicine Consultant with special interest in prenatal diagnosis
Dr Lumaan Sheikh Consultant Maternal Medicine, Co-ordinator Fetal-Maternal Medicine Fellowship Programme
Dr Nuruddin Mohammed Consultant Fetal Medicine.
Dr Shama Munim MBBS SMC; FRCOG UK Diploma Fetal Medicine, Royal College of Obstetrician and Gynaecologists, UK
Interim Chairperson of Obstetrics and Gynaecology
Dr. Lumaan Sheikh
MBBS DUHS; FRCOG UK; FCPS PAK;
Diploma in Maternal Medicine, Royal College of Obstetricians & Gynaecologists, UK.
Dr. Nuruddin Mohammed
M.B.B.S AKU; PhD (Fetal Medicine, S’pore); MSc (Fetal Medicine, S’pore); Di p. AOU (RCOG/RCR U.K); Fellowship MFM (S’pore)
Consultant, Fetal Medicine
Dr. Ayesha Malik
MBBS DUHS; FCPC PAK
Fellowship MFM Aga Khan University
MBBS PMC; FCPS PAK
Fellowship MFM Aga Khan University
Dr Shazia Masheer
MBBS DUHS; FCPS
Consultant with Special interest in Maternal Medicine
Part time Faculty
Professor Dr. Jahan Ara Pal
Senior Lecturer & Honorary Consultant with special interest in prenatal diagnosis