Events, features and things to do for families in New Hampshire
By Jeffrey R. Johnson, MD
For many women, pregnancy is an exciting time during which they partner with their obstetrician over many months to keep themselves and their developing baby healthy.
Unfortunately, sometimes there are complications during the pregnancy that need to be addressed by a specialist to ensure a healthy delivery. In these cases, obstetricians will refer their patients to a maternal-fetal medicine specialist.
We recommend that any woman thinking about getting pregnant be seen by an obstetrician. This visit can determine if the woman has any health issues that could be dangerous to, or made worse by, a pregnancy. If any health issues such as diabetes or high blood pressure are present, two of the most common chronic health condition, the patient may be referred to a maternal-fetal medicine specialist to formulate a plan to keep herself and the baby healthy.
In recent years, women have been waiting until later in life to get pregnant, which means they are more at risk for these health problems, but there is also the risk of genetic malformations in the baby, such as Down syndrome, as the age of the mother increases.
It is important for patients to know their genetic history and to understand the risks. Through pre-pregnancy testing, we can give women an idea about the probability and management of these risks. If a woman has not been to see an MFM specialist before her pregnancy and the obstetrician thinks it is necessary, an MFM specialist will work with them to adjust the mother’s medications or other appropriate plan for care during the duration of the pregnancy and will sometimes make recommendations for testing or special delivery scenarios for high-risk women.
Several invasive and non-invasive procedures are available to determine the general and genetic health of the baby. In the first trimester of pregnancy, a chorionic villus sampling (CVS) can be performed to determine potential genetic problems with the baby. This involves taking a small sample of the placenta and performing appropriate genetic testing.
In the second trimester of pregnancy, an MFM specialist can offer amniocentesis, which is taking a sample of amniotic fluid and determine any genetic problems by studying the sample. MFM specialists can also perform ultrasound tests to determine any physical malformations such as facial clefting, and a 3-D Doppler system can help us see vascular malformations or renal abnormalities that may be surgically correctable after delivery.
Ultrasound also allows us to see the location of the placenta, amniotic fluid volume and any problems that there may be with the umbilical cord. If we catch these issues early we can work out a plan to fix them or appropriately develop a plan for the mother to care for this child. It's important to talk with your provider about the benefits and risks associated with these tests.
Sometimes an MFM specialist will see a woman with a medical predisposition toward premature delivery. Using a hormone replacement called progesterone, we can reduce the risk of preterm deliveries by nearly 50 percent. In recent years babies as young as 23 weeks survive after a premature birth, where in the past the lower limit of viability was closer to 29 weeks, which has been a major step forward in the field of obstetrics.
Most women stick with their primary obstetrician for the delivery of their child so they can stay in their local community and be surrounded by friends and family. As mentioned above, sometimes an MFM specialist will recommend special birthing locations to make sure the mother and child can be put under intensive care during and after the stress of childbirth.
Pregnancy should be a joyous time, not a scary one. Through the recent significant advances in medicine and technology, an MFM specialist can work with hopeful and expectant mothers to make sure their pregnancy is happy and healthy.
Jeffrey R. Johnson, MD is a Maternal Fetal Medicine Specialist at Dartmouth-Hitchcock.