Janice Lynn Henderson, M. High-risk pregnancy is a term that can denote a wide variety of common conditions. Many of them are related to pre-existing conditions you may have had before becoming pregnant or conditions you may have developed while pregnant or during delivery. A high-risk pregnancy does not necessarily mean that your pregnancy will be more difficult or challenging than a low-risk pregnancy.
However, it does sometimes mean that you will need to consult a maternal-fetal medicine specialist and undergo more monitoring than someone with a low-risk pregnancy. Learn more about high-risk pregnancy from Janice Henderson, M. A: A maternal-fetal medicine specialist perinatologist receives a traditional obstetrics and gynecology education but with an additional three years of training to learn how to treat medical complications that are related to pregnancy. In addition, the maternal-fetal medicine specialist has extensive training in assessment and treatment of fetal problems.
Most perinatal ultrasound is interpreted by maternal-fetal medicine specialists. You may be referred to a maternal-fetal medicine specialist if you have a pre-existing medical condition prior to pregnancy, develop a medical condition during pregnancy or have problems during delivery. As part of a perinatology visit, patients can expect a detailed ultrasound that looks closely at the anatomy of the fetus.
Amniocentesis is among several other tests that can be performed, if necessary. The procedure involves taking a small sample of amniotic fluid, the substance surrounding the fetus. The sample contains genetic information that can be used to diagnose disorders, including open neural tube defects such as spina bifida , where the spine and spinal cord don't form properly.
When complications do arise, the patient can choose a course of action with guidance from the doctor. Many complications are not serious and some resolve on their own. Esakoff, referring to a condition that affects part of a fetus' kidney. She also notes that some women are at higher risk of complications than others.
Multiple births should always be monitored closely. Patients with diabetes, hypertension or autoimmune diseases should be cared for by a perinatologist too, as should women with medical histories such as pulmonary hypertension, organ transplantation or congenital heart disease.
Both mother and baby have higher odds of complications in these cases, so good planning and care are key. Risks include low birth weight, hypertension, preeclampsia—which can involve damage to the mother's kidney and liver—preterm labor, anemia and birth defects.
These doctors are obstetricians who have three additional years of training in helping women through high-risk pregnancies. Women with a history of heart disease, hypertension, diabetes, seizure disorders, autoimmune diseases, blood clotting disorders, or infections will benefit from the expertise of a MFM doctor.
Women carrying more than one baby will also need to see an MFM specialist. Your MFM doctor will help to monitor your prenatal care throughout your high-risk pregnancy. They may also do the following:. Instead, your medical team throughout your pregnancy will just expand to include the MFM specialist. The stresses and hormonal changes of pregnancy can also complicate psychiatric conditions. For both neurologic and psychiatric diseases, it is essential to plan ahead and choose treatments that keep a woman healthy while minimizing risk to the growing fetus.
These changes can increase her risk of some infections. Other infections can cause birth defects and may require specialized treatment during pregnancy. Changes to the immune system may also affect autoimmune disorders. When surgical emergencies occur in pregnancy, MFMs partner with surgeons to ensure the health of two patients at the same time. Pregnancy stretches joints and tissues, affecting women disorders of their bones, cartilage, and connective tissue.
For cancer survivors, pregnancy may stress organs that were strained by chemotherapy, requiring extra monitoring. In other cases, mothers receive a cancer diagnosis while pregnant. MFMs partner with medical and surgical oncologists to map out surgery, chemotherapy, and timing of birth to minimize risk to mother and child. Improvements in ultrasound, prenatal diagnosis, and treatment have made it possible to detect and, in some cases, treat, many birth defects before birth.
MFMs provide expert consultation for families who have learned of a birth defect, working with pediatric surgeons to determine the best plan of care for mother and fetus. When two babies share a single placenta, there are added challenges, because uneven blood flow can lead to problems such as twin-twin transfusion syndrome. MFMs monitor multiple pregnancies with ultrasound, and they can perform advanced procedures to treat complications such as twin-to-twin transfusion syndrome.
The fetal immune system is not ready to cope with certain infections, which can cause birth defects or growth problems. Advanced treatment and careful monitoring may reduce long-term effects of infections such as cytomegalovirus, toxoplasmosis, parvovirus, herpes, and varicella chickenpox. For families who lose their babies before birth, MFMs can help to determine what caused the loss and develop a plan to reduce risk in the next pregnancy.
Some mothers develop antibodies, such as anti-D and Kell, that can cross the placenta and attack fetal red blood cells. MFMs can test whether the fetus is at risk, use ultrasound to monitor for signs of anemia, and give intrauterine blood transfusions to support affected fetuses. MFMs perform a variety of tests to check the effectiveness of certain treatments as well as monitor fetal well-being.
We use 2D ultrasound to monitor fetal heart rate, fetal movement, and levels of amniotic fluid, and we use Doppler ultrasound to measure blood flow through the umbilical cord and the fetal brain and heart. These tests help sort out whether the fetus is getting what it needs in the uterus, or might be better off being born.
Healthy babies have enough fluid around them, but not too much. Using ultrasound, we can estimate whether a baby has too little fluid oligohydramnios or too much polyhydramnios. Both too much and too little fluid can be associated with birth defects and placental problems. Guided by ultrasound, an MFM can insert a needle into the umbilical cord to collect a fetal blood sample to diagnosis certain diseases. We can also give the fetus a blood transfusion to treat severe anemia.
In specialized centers, MFMs partner with pediatric surgeons to repair life-threatening birth defects before birth. Some procedures are performed endoscopically, through tiny incisions using cameras, such as for twin pregnancy or other fetal anomalies.
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