Answering Your Questions about High Risk Pregnancies

What is a high-risk pregnancy?

A high-risk pregnancy is one in which some condition puts the mother or the developing fetus (or both) at an increased risk for complications during or after pregnancy and birth.

Why might I need to be treated at the High Risk Pregnancy Center?

The High Risk Pregnancy Center is a maternal-fetal medicine (MFM) practice, and we’re here to help women who may have an increased risk for complications during their pregnancy. Patients come to us for our advanced ultrasound exams and our enhanced expertise in diagnosing and treating problems. However, the majority of first-time patients we see have only a minimal risk for complications, and most go on to deliver healthy babies.

How do I find a maternal-fetal medicine specialist?

The easiest way to find an MFM specialist is for women to ask their primary caregiver for a reference or referral. Most large maternity hospitals have MFM specialists affiliated with the institution. MFM specialists can also be found through the Society for Maternal-Fetal Medicine website.

Why should I have my ultrasounds done by a maternal-fetal medicine (MFM) specialist?

Recent studies have shown that women who have had advanced testing performed by MFM specialists, have a 3-fold increase in detection of abnormalities in comparison to community-based radiology or ob/gyn offices. In one recent study done in Las Vegas and published in the Journal of Ultrasound in Medicine, 100% of fetal heart defects requiring surgery were detected by MFM specialists, in comparison with only a 35% detection rate in general obstetrician and radiology centers. By diagnosing these kinds of problems early, we can work with your primary doctor, obstetrician or pediatrician to give you the very best chance at a healthy pregnancy and delivery.

What procedures do MFM specialists perform?

The MFM specialists at the High Risk Pregnancy Center (HRPC) are highly trained in obstetric ultrasound, and we perform both screening and diagnostic examinations of the fetus, placenta, uterus, and cervix at key times during gestation. In addition to common obstetric procedures such as amniocentesis and cesarean delivery, HRPC physicians have specialized training in chorionic villus sampling (CVS), percutaneous umbilical cord sampling, fetal transfusion, fetal biopsy, and diagnostic fetoscopy. We also perform procedures specific to multiple gestations such as multifetal pregnancy reduction and laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome. MFM specialists may also be involved in procedures related to critically ill patients, including cesarean hysterectomy, placement of central lines, intubation, and ventilation.

When during pregnancy does a woman see a maternal-fetal medicine specialist?

Before pregnancy, MFM specialists can help women think about and prepare for the risks of pregnancy, especially when the patient has medical conditions such as diabetes or hypertension. Similarly, if a woman has had a poor pregnancy outcome before, consultation can be helpful in planning for the subsequent gestation. During pregnancy, MFM specialists care for women with preexisting health problems, conditions that arise during the pregnancy (e.g., gestational diabetes and hypertension, placental bleeding, preterm labor, and early rupture of membranes), and those who have complications relating to the fetus itself. As these complications occur, MFM specialists develop a plan of care with their doctor. Sometimes, the MFM specialist will need to assume responsibility for care if this is beyond the expertise of her obstetric caregiver. Complications can occur even after a pregnancy is over (e.g., postpartum hypertension, excessive bleeding, resistant infection), and some complications in pregnancy can have long-term implications for the woman’s health. The MFM specialist can provide care for the immediate problem and help these patients establish a plan to prevent or limit future complications.

What is the range of care provided by maternal-fetal medicine specialists?

Maternal-fetal medicine physicians specialize in the diagnosis, treatment, and care of expectant mothers and their unborn babies who may be at high risk for health problems. Some women require a single consultation before or during pregnancy to evaluate their condition and coordinate their care with their obstetrician, family practitioner, or nurse-midwife who may be less familiar with managing concurrent illnesses or complications of pregnancy. Others may warrant ongoing MFM specialist care, such as monitoring their condition through regular prenatal visits, performing fetal assessments with ultrasound and/or invasive procedures, and participating in delivery. Following delivery, MFM specialists may be consulted to diagnose or manage adverse or unusual pregnancy or postpartum events.

I have chronic health conditions and I’m pregnant. Should I be monitored by an MFM specialist?

You may need to be under the care of an MFM specialist during your pregnancy if you suffer from certain chronic medical conditions. The most common include hypertension, diabetes, seizure disorders, autoimmune diseases, and blood clotting disorders. Certain infectious diseases that can affect both mother and child, such as HIV, cytomegalovirus, and parvovirus are often managed by MFM specialists as well. MFM specialists provide care for women who are at increased risk for preterm birth (including those with multiple gestations), women with cervical insufficiency who may require a surgery to prevent preterm birth, and women with placental problems such as bleeding from premature separation (placental abruption). In addition, MFM specialists are often responsible for the management of preterm labor, premature rupture of membranes, and other complications during labor that have the potential to impact newborn and long-term infant outcomes.

What common fetal illnesses are managed by maternal-fetal medicine specialists?

Numerous fetal illnesses and abnormalities are managed by MFM specialists. These include structural malformations (birth defects), chromosomal abnormalities, genetic syndromes, cardiac arrhythmias, blood disorders, congenital infections, and intrauterine growth abnormalities. Because MFM specialists are specially trained in diagnostic ultrasound, they can play an important role in screening for fetal chromosome abnormalities and birth defects. For optimal care, certain birth defects, such as neural tube defects (spina bifida) and congenital heart defects require a multidisciplinary approach, and MFM specialists often coordinate this in preparation for delivery. Pregnancies complicated by fetal illness may require specialized care that can include fetal testing, interventions, and determining the timing and route of delivery to optimize neonatal outcome.

Are there other specialists that MFMs work with?

MFM specialists often coordinate the care of their high-risk pregnant patients with the woman’s obstetrician to develop a plan of care that is tailored to her needs and those of her unborn child. They are experts in understanding the risks to the mother and bringing in the right medical and surgical subspecialists, anesthesiologists, and critical care team members if the maternal condition warrants. MFM specialists communicate and work directly with the neonatologist and/or other pediatric subspecialists to ensure an optimal plan for newborn care.

What kind of research does a maternal-fetal medicine specialist do?

In general, MFM specialists aim to discover how to improve the health of pregnant women and/or that of their unborn child. These studies encompass many types of investigations such as laboratory studies of the smallest molecules that govern the development of pregnancy, clinical studies of medicines or interventions to improve pregnancy outcomes, and public health studies of systems that can assist pregnant women in getting the most effective and efficient care.

What role do maternal-fetal medicine specialists play in education?

MFM specialists play a crucial role in educating the next generation of obstetric providers and teaching the fellows who will become future MFM specialists. MFM specialists contribute to the teaching of medical students and resident physicians, and play a key role in continuing education for physicians, nurses, midwives, and other healthcare providers involved in the care of women during pregnancy. In many communities MFM specialists are also involved in quality reviews regarding serious maternal and newborn complications, with a goal of helping all clinicians and institutions to provide up-to-date patient care.

For more information, or to schedule an appointment with one of our MFM specialists, call the High Risk Pregnancy Center at 702-382-3200. You can also schedule an appointment using our easy online form.