ABSTRACT
This chapter was written in line with the need to revolutionize maternal fetal medicine by returning the M (maternal) to the MFM subspecialty (maternal–fetal medicine) by introducing a new paradigm of care composed of novel technologies and comprehensive services in order to reduce maternal and fetal morbidity and mortality. A three-floor service model is introduced, composed of the prepregnancy clinic, the inverted pyramid of antenatal care, and the postpregnancy clinic, each with a combined methodology composed of existing and novel testing procedures (such as preglycemic evaluation in the prepregnancy clinic, free circulating DNA during the first trimester, or echocardiography of the newborn in the postnatal service, among many others). All floors begin at the level of community clinic/family obstetrician before the high-risk specialists are called to service and introduce a contingency management and prevention follow-up. The approach expresses the need to provide comprehensive service starting from a traditional patient evaluation spanning medical and pregnancy history and demography, biochemical and biophysical markers, sonography, chemical blood tests, and introducing “omics” to fetal medicine. This approach enables personalized medicine and a systematic method to focus the medical attention on those who need it most, allowing the others to have a less intensive medical involvement. It fits the new world of social media, computerized algorithms derived from mega databases, and the need to integrate all sources of information and know-how to generate an evidence-based medical treatment plan as required in today’s world of medicine. This chapter calls for introducing training and education to the new doctor generation and to systematically adjust the maternal–fetal medicine (MFM) system of care in order to achieve the required improvement in maternal and fetal health.
