Maternal-Fetal Medicine

Women who become pregnant after age 35 are more likely to have pre-existing health problems that can complicate pregnancy and are at greater risk for complications like high blood pressure, abnormal fetal growth, and diabetes in pregnancy. There is also an increased risk for certain fetal genetic abnormalities, specifically trisomies (where the fetus has an extra chromosome).

Pregnancy places extra stress on a woman's heart and circulatory system, causing the heart to work harder. The labor and delivery experience also adds to the heart's workload.

A variety of risk factors can make a pregnancy high-risk, including advanced maternal age, chronic health conditions, problems with a previous pregnancy and problems that develop during pregnancy. A high-risk pregnancy means the baby is at a higher risk of having health problems during pregnancy, birth or after delivery. Women having a high-risk pregnancy should be seen more frequently for close monitoring by a maternal-fetal medicine specialist, a physician specially trained to treat high-risk pregnancies.

Hypertension or high blood pressure, can be present before pregnancy (chronic hypertension) or develop during pregnancy (gestational hypertension). Pregnant women with hypertension are at risk of developing preeclampsia, experiencing both high blood pressure and protein in the urine, which can lead to serious complications for both the mother and baby.

While women with very mild kidney disease (stages 1-2), who are otherwise healthy, can expect to have a healthy pregnancy, those with moderate to severe kidney disease (stages 3-5) experience a much higher rate of complications.

Obesity during pregnancy puts both the mother and baby at serious risk of developing serious health problems, including gestational diabetes, preeclampsia, birth defects, preterm birth and pregnancy loss.

A term used to describe infants born before the 37th week of pregnancy. Infants born prematurely may experience motor, language, cognitive or other developmental delays, sensory losses such as hearing or visual impairment or feeding difficulties.

Critical care obstetrics and delivery is the specialized multidisciplinary practice of managing critically ill obstetric patients during pregnancy, delivery and postpartum. Critically ill pregnant women are generally admitted to the labor and delivery unit equipped with critical care and obstetrical monitoring equipment. The multidisciplinary approach involves neonatologists, obstetric anesthesiologists, critical care physicians, nurses, respiratory therapists and other related specialists working together to protect the lives of both mother and baby.

Women diagnosed with diabetes before or during pregnancy have difficulties producing the appropriate amount of insulin to process glucose, or sugar, in their bodies. Improper management of diabetes during pregnancy can lead to serious health problems for both the mother and baby. A maternal-fetal medicine (MFM) specialist is specially trained to treat women with diabetes during pregnancy. Through frequent prenatal visits, an MFM specialist can monitor and provide recommendations to help manage blood glucose levels through a combination of healthy eating, exercise and medications.

Support provided by a genetic professional or qualified physician to the patient and the doctor by identifying genetic risk, discussing family history, explaining available testing options and implications of test results, as well as providing patient education. Genetic counselors or qualified physicians, act as patient advocates translating medical and scientific knowledge into practical information. In addition, resources are available to provide support to anyone who may be at risk for a variety of inherited conditions or birth defects, such as cystic fibrosis or disorders common to a particular race or ethnic group. This information is provided in a non-directive, unbiased manner and allows the patient to make their own decisions regarding testing options.

In vitro fertilization combines an egg and sperm for fertilization outside the body (in vitro), such as in a test tube or culture dish. The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum (mature female reproductive cell) from the ovaries and enabling sperm to fertilize it in a laboratory environment.

Maternal-fetal medicine specialists are available to provide additional monitoring and comprehensive care to women with high-risk pregnancies who are hospitalized prior to delivery.

Pregnant women carrying multiples (twins, triplets, quadruplets, etc.) are at an increased risk of experiencing complications such as preterm delivery, low birth weight and preeclampsia. A maternal-fetal medicine specialist specializes in the care of women experiencing a high-risk pregnancy, such as multiples, and has the additional training and experience required to treat any complications experienced during a pregnancy.

An evaluation of a woman's current health and medical history to help identify opportunities to better prepare the body for becoming pregnant and to counsel her on risks and management of future pregnancy. The evaluation may include a review of the patient's current lifestyle and medical/obstetric history, including current medications, screening and treatment for any infectious diseases, immunization updates, education and recommendations on behavior modifications to reduce risk factors.

Prenatal counseling (also called prepregnancy or pre-conceptual counseling) involves one or more visits with a health care professional, such as an obstetrician, maternal-fetal medicine specialist or certified nurse midwife, before becoming pregnant to identify potential risk factors that need to be addressed and help ensure the woman is in the best possible health prior to pregnancy. Prenatal counseling typically includes a prenatal risk assessment for any potential complications of pregnancy. The health care professional may modify risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects. It also includes counseling on smoking cessation, alcohol reduction and medications that may compromise fetal development. The purpose is to allow a woman to better prepare her body for successful conception and pregnancy and enables her to reduce any health risks before conceiving.

A diagnostic test to screen for chromosome abnormalities and inherited disorders. A sample of amniotic fluid is collected through an ultrasound guided needle inserted into the amniotic sac. The amniotic fluid is sent to a laboratory for analysis.

Antenatal or prenatal diagnostic screening, refers to a variety of testing options available to determine if a fetus has certain abnormalities. Many of the tests are conducted by an obstetrician (OB) as routine prenatal screening, including ultrasound, nuchal translucency screening and testing of a pregnant woman's blood to help estimate the risk of certain abnormalities. When a test indicates a higher risk, additional tests are available to further analyze the fetus. These additional tests, such as amniocentesis and chronic villus sampling, are often more invasive and have additional risks to the fetus and should be conducted by a maternal-fetal medicine (MFM) specialist.

CVS is a diagnostic test to screen for chromosome abnormalities and inherited disorders by analyzing the chorionic villi cells from the placenta. The placenta cells are collected either transcervically, using an ultrasound guided catheter inserted through the cervix to gently suction the cells, or transabdominally, through a long thin needle inserted into the placenta through the abdomen.

Cystic fibrosis (CF) carrier screening is a genetic test that determines if a mother or father is a carrier of the changed gene that causes CF. The test identifies if either parent has an increased chance of having a child born with CF. A prenatal diagnostic test determines if the fetus has CF or is a carrier if a woman is already pregnant.

This type of genetic test screens for disorders based on patients' ethnicity or family history. Certain ethnic groups have higher rates of carriers for specific genetic disorders. If both partners are members of a high-risk group for a certain disorder, carrier screening may be recommended as part of preconception or prenatal care.

A non-invasive exam using ultrasound technology to generate pictures of a baby's heart. A maternal-fetal medicine (MFM) specialist or pediatric cardiologist will review the images to identify any congenital fetal heart anomalies.

A high-risk ultrasound enables a maternal-fetal medicine specialist (also called a perinatologist) to identify potential problems of a fetus using advanced ultrasound equipment. The high-risk ultrasound allows specialists to examine the developing baby's organs, umbilical cord, amniotic fluid levels, placenta and fetal heart rate to help determine if the fetus is developing as expected.

Our maternal-fetal medicine doctors have special training and certification to perform types of ultrasound that may not be available from a radiology service or a general obstetrician. These exams are performed in special situations, not in every pregnancy. Special exams include: Biophysical profile (A focused check of fetal movements and amniotic fluid (the liquid surrounding the fetus) to check on fetal well-being), Cervix length (If the cervix is short, there is a risk of preterm birth and special treatment might be needed), Doppler (Measurement of blood flow through certain blood vessels (umbilical cord, arteries in fetal brain, other blood vessels) to check on fetal well-being), Fetal echocardiogram (A detailed exam of the fetal heart to look for heart defects), 3-D Ultrasound (still pictures that appear 3-dimensional. These are used to get details for certain types of birth defects), 4-D ultrasound (Videos that appear 3-dimensional. These are used to get details of certain types of birth defects).

Ultrasound is a method to get pictures or videos of the fetus (unborn baby). It can be used to help determine the due date, to find out whether there is only one fetus or multiples (twins, triplets, etc), to check on whether the fetus is growing normally, and to look for birth defects or other problems. The method uses sound waves to make the images, not x-rays or radiation. Ultrasound is painless and safe for both mother and fetus.