Obstetricians who specialize in high-risk pregnancies are known as maternal-fetal medicine specialists. If an individual faces any type of high-risk pregnancy, a maternal-fetal medicine specialist is necessary. A high-risk pregnancy is one where the mother is at risk for developing problems due to age, previous pregnancy problems, existing conditions or the development of issues during pregnancy such as high blood pressure or gestational diabetes. High-risk pregnancies can also result in complicated births, and maternal-fetal medicine specialist is trained to deal with these situations such as emergency caesareans.
Many of these obstetricians are on the cutting edge of research because the high-risk population is where novel treatments are often tried first. The treatments provided by these types of obstetricians allow early recognition of problems in pregnancy and with fetal development. An obstetrician that focuses on high-risk pregnancies will be able to offer the patient prenatal care and monitoring, testing, and medical and surgical interventions to assure the health of both mother and baby. If you are in Melbourne you should visit East Melbourne Obstetrics and Gynaecology.
Prenatal care and monitoring
Preventive prenatal care and early monitoring can allow a patient to avoid many complications of high-risk pregnancy. An obstetrician focusing on high-risk pregnancies offers increased monitoring during prenatal care visits. This often includes more frequent prenatal care visits, advanced ultrasounds, genetic testing, increased monitoring, and preventative care, for mother and baby.
Patients of maternal-fetal specialists have access to numerous tests that can predict or indicate problems with mother or child. In this way, problems that develop with the mother such as blood pressure or diabetes and different fetal abnormalities such as genetic or physiological can be caught early. From common ultrasounds, amniocentesis and chorionic villus sampling to more advanced techniques such as cervical length testing and cell-free DNA analysis. These physicians also know how to treat pregnancy-related complications such as placental positioning problems, preeclampsia, anemia, and gestational diabetes. They use a combination of medications from vitamins to insulin to progesterone to treat these conditions.
To treat these conditions, a maternal-fetal specialist has a wider variety of tools available. One problem with a high-risk pregnancy might be maintaining the pregnancy. This can be corrected by medicating the mother with progesterone. This is a medication that while helping the mother does not harm the baby. A mother at risk of preterm labour might be given a medication such as terbutaline to prevent contractions. There are also medications that can help a baby develop more quickly if at risk of preterm birth. Different steroids can be given that stimulate organ development.
Maternal surgical interventions
One of the interventions that obstetricians who specialize in high-risk pregnancies use is different surgical procedures. These procedures take care of pregnancy abnormalities such as preeclampsia to assure a healthy delivery. Some of these surgical interventions are to fix placental irregularities such as placenta previa, placenta accreta, or placental abruption. Laparoscopic treatment for ovarian torsion syndrome. Other surgeries include transabdominal cerclage and cervical cerclage.
Fetal surgical interventions
Problems or congenital abnormalities are caught early by a high-risk specialist. Many of these birth defects are now repaired prenatally before birth due to advances in research and surgical techniques. Some of these techniques include fetoscopic laser therapy, which uses an endoscopic laser inserted through an incision in mother’s abdomen, open uterus surgery which is indicated for neural tube repair, to fix the defects that are caused by it failing to close and surgical interventions using catheters to fix heart valves.
A Wide Spectrum of Professionals
The field of high-risk obstetrics has many fine professionals. The breadth and depth of their various interests is fascinating. The following doctors are examples of some of the fine representatives in the field.
- Dr Jeanne S Sheffield is the director of maternal-fetal medicine for The American Board of Obstetrics and Gynecology and the Director of Maternal-Fetal Medicine at Johns Hopkins. One of her interests is the relationship of microcephaly (an infant head that is abnormally small) and the Zika virus.
- Ramen Chmait is a professor at the University of South Carolina’s Keck School of Medicine. He performs in utero surgeries. One of his latest was a fetoscopic laser surgery for Twin-Twin Transfusion Syndrome performed at 20 weeks of pregnancy.
- Dr Kelly Bennett is director of Maternal Fetal Medicine at Vanderbilt University Medical Center. She is known internationally as a high-risk specialist. She encourages a team atmosphere among her doctors. She also studies the management of preeclampsia and cervical monitoring.
The top concerns for researchers are maternal and perinatal morbidity and mortality. There is also a focus on genetics with the hope that one day physicians may be able to test for the whole genome of the baby.
- Genetics and prenatal diagnosis
Norton et al. have discovered a non-invasive method for prenatal testing to determine the baby’s DNA using the mom’s blood which has significantly lower false positive results. The technique called cell-free DNA analysis for trisomy, screens for fetal aneuploidy. Fetal aneuploidy is MORE. The screening has a much lower false positive rate and less risk than traditional screening such as amniocentesis.
- Preterm Birth due to Cervical Abnormalities
Roberto Romero et al. did a study that offers additional help for treatment with vaginal progesterone to decrease the risk of giving preterm birth, infant death and neonatal complications in pregnant women, who have a short cervix.
- Prenatal Heart Surgery
Doff McElhinney has used in utero surgery to fix an infant’s heart before birth so it does not suffer from heart disease. The disease progression, hypoplastic left heart syndrome, was halted by using a catheter to reach the baby’s heart and enlarge the heart valve.
The obstetricians who have dedicated themselves to high-risk pregnancies know the stress and worry such a pregnancy can cause a woman. They are diligent in their efforts to bring these pregnancies to successful conclusions. From the initial visit to the successful birth, maternal-fetal specialist guides a high-risk pregnancy with care and meticulousness.