When you step into Prof Sikolia Wanyonyi’s office, his world comes alive: African portraits of expectant mothers line the wall, a thick obstetrics textbook sits on the shelf, and an ultrasound machine hums softly in the corner.
To the untrained eye, its grey and coloured images are abstract patterns; to him, they reveal the story of a baby’s health, organs, and survival.
We sat down with Prof Wanyonyi, 48, one of Kenya’s few fetal medicine specialists, to understand the science — and humanity — behind treating babies before birth.
I always wanted to do obstetrics since my early days in medical school. Pregnancy fascinated me — how a small dot in the womb becomes a baby kicking and crying at birth.
But over time, I realised that the baby is a little person on their own, and sometimes they develop conditions. Fetal medicine, a branch of obstetrics, is about finding ways to help that baby and optimise their health before birth.
What training does it take to become a fetal medicine specialist?
It’s a long journey. It took me six years of medical school at Moi University. I graduated in 2003. Then I did one year internship at Machakos General Hospital, two years as a senior health officer at the Aga Khan Hositial, followed by four years of residency in obstetrics and gynaecology.
After that, I did two years of sub-specialisation in the UK and another one and a half years in Spain at the University of Barcelona. So, altogether, at least 13 years.
Which skills matter most in your work?
Ultrasound is at the heart of it — about 90 percent of fetal medicine. You must be very good at ultrasound, see what others miss in those black-and-white images.
Then comes intervention in the womb where space is limited, so precision is key. You have to master different procedures. The baby is tiny, the instruments are tinier, and you cannot afford to do the procedures with shaky hands.
Beyond that, communication is crucial because sometimes you deliver the best news, sometimes the worst to the expectant parents.
Then of course, time management skills, because consultations can be time-consuming. At times you are booked to see five patients, each scheduled to take 30 minutes, but because some cases are complex, you spend one and a half hours with one patient. So, you have to know how to manoeuvre around that and still have time for yourself.
What exactly do you look for on an ultrasound?
We scan the baby head to toe. From around 20 weeks, you can visualise everything very well; brain, heart, lungs, abdomen, kidneys, bladder, limbs. But the challenge is, babies don’t follow instructions. They curl up, flip upside down. Sometimes we have to wait or gently rock them before we can see properly.
Who needs to see a fetal medicine specialist?
Mostly women referred by their doctors, sonographer or midwives after an anomaly is suspected — babies with abnormalities or medical conditions affecting their health.
What kind of problems can you treat inside the womb?
Quite a range. If a baby doesn’t have enough blood, we give a transfusion. If a mass is compressing organs, we remove it. If fluid is building up, we drain it.
Some conditions we can’t fix immediately and we have to wait until the baby is born. Unfortunately, some abnormalities can't be fixed at all, but we prepare the baby for care after birth.
How long does a transfusion take?
It takes about 30 minutes to one hour at most. But you have to get the right blood. Laboratory specialists have to prepare blood in a certain way and use certain specialised equipment. Depending on what is behind the inadequate blood, we may have to transfusion more than once.
The other thing is babies are constantly growing. For instance, the amount you'll give at 24 weeks is not the same amount that you'll give to a baby at 28 or 30 weeks.
What is your most memorable transfusion case?
The closest to my heart is one mother had lost four children to anaemia. We managed transfusions for her, and that baby survived. At the naming ceremony, she asked if she could name him after me. It was touching, though I was uncomfortable about it.
At what ages of the mothers do complications most often need your interventions?
It cuts across. These complications do not know age. Of course, they are much more common in older women.
Dr Sikolia Wanyonyi; a consultant in obstetrics and fetal medicine with a patient at Aga Khan University, Nairobi.
Photo credit: Pool
Are there signs expectant women should look out for?
Unfortunately, for most there are no symptoms that the mother can feel. You can only pick it during routine antenatal care or ultrasounds. The key thing is attending proper antenatal care.
How do you balance treating the foetus while keeping the mother safe?
You have to understand that our medium of treatment is the mother. The mother houses the baby so, you can only treat the foetus through the mother. For instance, if you need to help with the heartbeat of the baby, you give the mother drugs so that they go through the placenta to the baby. The good thing is that the baby doses are very small.
What are the most serious conditions you treat?
The most serious are heart conditions, where the baby's heart is not well developed or has defects. Think about cases where the vessels that drain the heart are not well aligned or are not doing their work properly.
The other common one is growth disorder. Some babies, for whatever reason, just don’t grow. So, we deliver the baby prematurely and feed him or her.
What are the biggest challenges you face?
Late referrals. Many mothers don’t get early antenatal care, or ultrasounds are done by staff without specialised training, so problems are missed. Cost is another barrier, and access is uneven — someone from Maralal may not make it to Nairobi for care. We need more specialists across the country.
How has technology changed your field?
Dramatically. Ultrasound machines are sharper and smarter. Artificial intelligence is already integrated into some scans. Telemedicine lets me consult with colleagues in the UK and Spain. And genetics has advanced — lab tests now help us identify causes behind many fetal problems.
