Subspecialization in Perinatal Medicine

The management of high risk pregnancies and fetal pathology is a frequent problem and antenatal diagnosis increasingly requires a multidisciplinary approach. In some cases, it will require the involvement of an individual who has had special training in feto-maternal and neo-natal physiology and pathology as well as genetics, embryology, fetal and maternal screening and diagnostic procedures and perinatal care and counselling. EBCOG notes with approval the development of subspecialty practices in a number of countries and considers that feto-maternal medicine should be recognised as a subspecialty, in Europe.

Educational objectives and requirements for training in these subspecialist areas have been defined in conjunction with acknowledged experts from the European Association of Perinatal Medicine (EAPM) and are defined in the syllabus. The role of a subspecialist is complementary to, and not in competition with, that of the specialist in Obstetrics and Gynaecology.

Training of the maternofetal medicine subspecialist:

1. Definition: The Feto-Maternal and Perinatal Subspecialist is a specialist in Obstetrics and Gynaecology who has had a theoretical and practical training in:
a. detailed risk assessment before during and after pregnancy;
b. ante-natal diagnosis of the wide range of materno-fetal disorders, some of which may require an invasive procedure;
c. management of very high risks pregnancies during the ante-natal , intra-partum , and post-partum period.
The practice of feto-maternal and perinatal medicine excludes the subspecialist from training and practice in another subspecialty.

2. The aim of the training
To improve the care of women and fetuses who are at high risk, in collaboration with others care providers.

3. The objectives of the training
To train a subspecialist to be capable of:

• improving knowledge, practice, teaching, research and auditing;
• co-ordinating and promoting collaboration in organising the service;
• providing leadership in development and research within the subspecialty.

4. The organisation of training

• The number of training posts should be strictly regulated by the relevant national body in order to provide sufficient expertise.
• Training programmes should be in a multidisciplinary centre of Obstetrics and
• Gynaecology and should be organised by a subspecialist or an accredited subspecialist.
• Centres should use the guidelines and protocols which are finalised by national professional bodies and are reviewed at regular intervals.
• Training as a subspecialist in feto-maternal medicine does not imply that the subspecialist cannot practise in the generalist field of Obstetrics and Gynaecology.
• Initially there will be a transitional period when accreditation for training will be given by the national appointing authority to a specialist in Obstetrics and Gynaecology with proven scientific and clinical expertise in Feto-Maternal and Perinatal Medicine. Subsequently, only individuals with training in the subspecialty should hold such a position.

5.1 Entry requirements:

• a recognised specialist qualification in Obstetrics and Gynaecology or have completed a minimum of five years in an approved training programme in Obstetrics and Gynaecology.
• the availability of a recognised training post.

5.2 An adequately remunerated post in a recognised training programme is a basic condition. Each trainee must be allocated a tutor to provide guidance and advice.

5.3 For each country, the estimated number of training posts should reflect the national need for subspecialists in feto-maternal and perinatal medicine, as well as the facilities and finance available for training.

5.4 Trainees should participate in all relevant activities of the training unit such as the care of out-patients and in-patients, on call duties during both day and night, performing ultrasound examinations and intra-uterine procedures and participating in educational activities, including the teaching of other health professionals. Participation in audit and clinical or basic research is essential.

5.5 Arrangements for postgraduate training must be compatible with national employment and teaching legislation in relation to remuneration, hours of work and rights of employees in such matters as sick leave, maternal and paternal leave and compulsory military service.

5.6 The duration of subspecialty training should include a minimum of two years in an approved programme and should cover the clinical and research aspects of the following areas:

• Ultrasound and other imaging procedures;
• Genetics;
• Neonatology;
• Maternal and Fetal Surveillance in high risk pregnancies;
• Basic Science e.g. maternal and fetal physiology, histo-pathology and embryology;
• Counselling.

5.7 Training should be structured throughout with clearly defined targets to be met after specified intervals. An educational plan should be drawn up in consultation with the trainee at the beginning of each attachment and progress should be monitored regularly, by mean of the Log Book.

5.8 A trainee may spend some training time in another (1 or 2) centre(s) recognised by EAPM, after approved by the appropriate national committee.

6.1 In all European countries, approval of training and trainers should be the responsibility of a national or regional authority which has the power to withdraw recognition, if necessary.

6.2 Approval of a training centre should be based on:

• annual statistics;
• internal quality control and audit;
• organised teaching sessions;
• availability of a:
• clinical genetics unit;
• intensive neonatal care unit;
• neonatal surgical unit;
• adult intensive care unit;
• designated place for caring for severely ill women;
• perinatal pathologist;
• multi-disciplinary team regularly involved in the management of high risk pregnancies;
• fulfilment of defined criteria for minimum activity for each trainee per year:
• 200 supervised high risk pregnancies and deliveries;
• 200 advanced ultrasound examinations;
• 200 fetal invasive procedures (amniocentesis, chorion villus sampling, fetal blood sampling).

6.3 Assessment of the trainee should be carried out by a national or federal committee of experts and should take into consideration:

• participation in Feto-Maternal Medicine courses, in particular those recognised by EBCOG, advised by the European Association of Perinatal medicine ( EAPM);
• completion of a Log Book of clinical experience in Feto-Maternal Medicine;
• peer review publications in a nationally recognised journal.

6.4 A representative from the EBCOG may be an observer on the national or federal assessment committee.

6.5 EAPM in conjunction with EBCOG organises an evaluation visit to a subspecialist unit, if requested.

	APPLICATION FORM-1
	APPLICATION FORM-2
	EAPM TRAINING PROGRAMME

Please send your application to subspecialty@europerinatal.com