Maternal Fetal Medicine

Before pregnancy, MFMs can provide advice for women with chronic health conditions, or those who have experienced un-routine pregnancies in the past. At a preconception consultation, the MFM reviews a woman’s medical and pregnancy history and helps to map out an optimal strategy for her next pregnancy.

MFMs use ultrasound, blood tests, and procedures such as amniocentesis to look inside the womb and evaluate the developing fetus. We use advanced skills in 3D and 4D ultrasound and fetal echocardiogram to screen for birth defects and chromosome problems. We also work closely with genetic counselors to offer tests such as integrated screening, non-invasive prenatal testing, chorionic villous sampling, and amniocentesis.

Diagnostic amniocentesis – Guided by ultrasound, the MFM uses a needle to collect a small amount of amniotic fluid. We use this fluid to test for genetic diseases, fetal lung maturity, or infection.
Therapeutic amniocentesis – When a fetus has too much amniotic fluid, the MFM can place a needle in the uterus, guided by ultrasound, and remove extra fluid. This process can reduce risk of early birth and treat certain fetal diseases
Chorionic villus sampling – In a CVS, the MFM uses a thin tube or a needle to sample the placenta during the first third of the pregnancy. The MFM uses ultrasound to perform a CVS, either through the cervix or the abdomen. We can test the placental sample for certain fetal diseases and health conditions.

MFMs work with other OB providers to ensure high quality care during labor and childbirth. We provide expert advice on when to induce labor, when and how to monitor the fetal heart rate. Our training provides us with advanced skills for attending complicated births, such as vacuum or forceps-assisted births, cesarean birth, or trial of labor after cesarean.

Women who have experienced the un-routine in the past face higher risks with their next pregnancy. In other cases, unexpected problems arise during pregnancy. We help manage problems such as:

Recurrent pregnancy loss – Women who experience multiple miscarriages may have an underlying health problem that makes it more difficult for them to carry a pregnancy. MFMs can assess for such problems and recommend treatments to reduce risk in the next pregnancy.

Early contractions (preterm labor) or water breaking (PPROM) – For some women, the normal events of labor start too early, putting the fetus at risk of being born before he or she is ready for the outside world. MFMs give drugs to slow preterm labor and steroid injections that jump-start the baby’s biology, preparing him for the outside world if he is born early.
Shortened cervix: The cervix keeps the uterus closed until it is time birth. However, some women experience cervical insufficiency, a painless thinning of the cervix that can lead to early birth. MFMs work with mothers and their OB providers to treat early thinning cervix with medications or surgery to prevent early birth.
Cerclage – In some cases, surgery can strengthen a thinning cervix. In this procedure, the surgeon sews the cervix shut, either through the vagina or through an incision in the abdomen, to prevent pregnancy loss. Some surgeons perform this procedure with minimally invasive surgical techniques, including robotic assisted cerclage.
Preterm birth in a prior pregnancy: Multiple factors can impact a mother’s risk of birthing too soon. MFMs can identify problems, such as a misshapen uterus, that can contribute to early birth. Based on this evaluation, they recommend therapies to prevent preterm birth in the next pregnancy.

In healthy pregnancies, hormones lower a woman’s blood pressure and direct food and oxygen to the womb. Sometimes, however, signals from the placenta increase a woman’s blood pressure, leading to problems such as gestational hypertension, preeclampsia, HELLP syndrome, and eclampsia. The cure for these conditions is to deliver the baby, but this is risky when high blood pressure develops months before a baby’s due date. In these situations, MFMs assess the pros and cons of staying pregnant vs. giving birth to improve outcomes for mother and baby. For women who have previously had blood pressure problems during pregnancy, MFMs can map out a strategy to minimize risk for their next birth.

Pregnancy can worsen existing health problems, such as high blood pressure, diabetes, or kidney disease, and these chronic conditions can affect pregnancy. MFMs monitor these un-routine pregnancies and offer expert guidance on what medications can manage mom’s medical problems with minimal risk to baby.

MFMs provide care after birth for women who experience complications such as heavy bleeding, bloodstream infections, surgical complications or seizures. We partner with intensive care specialists to care for the sickest new mothers.

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. In other conditions, the MFM opens the uterus to allow open open fetal surgery for birth defects such as spina bifida.

Carrying two or more babies increases risk for early labor and problems with growth, as the mother’s uterus stretches to accommodate multiples. 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.

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.

Central nervous system
Spinal cord (Spina Bifida)
Chest
Heart
Structural
Arrhythmias
Gastrointestinal
Genital
Kidney and bladder problems
Skeletal dysplasias
Umbilical cord
Chromosome problems, such as Down Syndrome (Trisomy 21), Trisomy 13 and Trisomy 18
Syndromes
Exposure to drugs and chemicals

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.