Important Steps to Help Ensure a Healthy Pregnancy - Obstetrical Screening Practices

Pregnancy is a time filled with many different emotions, from excitement to nervousness and a little bit of everything in between. An important part of ensuring a healthy pregnancy for both mother and baby is proper prenatal care. Prenatal care includes routine visits to an obstetrician/gynecologist to track the unborn baby’s growth and development, as well as monitor the health of an expectant mother and test for a number of treatable conditions. These conditions include anemia and other blood disorders, infection, high blood pressure, diabetes, fetal growth problems, amniotic fluid problems, placental problems, and women at risk for preterm birth. Screening with ultrasound is also important to identify fetuses that may need early intervention before or after birth. Depending on the complexity of care needed, your provider may determine it necessary to deliver at an academic medical center.

Crystal Run’s fellowship-trained maternal-fetal medicine specialists are high-risk pregnancy doctors that are trained to treat various obstetrical, medical, and surgical complications of pregnancy. Our Maternal Fetal Medicine Services provide care for both mother and baby, utilizing the most advanced diagnostic and therapeutic techniques available for optimal management of complicated, high-risk pregnancies. Many conditions in pregnant patients are treatable, however if left unnoticed or untreated, could be detrimental to the health of the mother and/or fetus. Most women screen negative and are considered to have low-risk pregnancies; these women will most likely never need to see the high-risk doctor. Those that screening tests come back positive for abnormalities, will be considered high-risk and will be referred to have one or more visits to the maternal-fetal medicine specialist.

It is our recommendation that every pregnant woman be screened with a first trimester and a second trimester ultrasound to detect fetal, cervical, placental, and amniotic fluid abnormalities. At the time of the first trimester ultrasound, the expectant mother will have the choice of whether or not to proceed with genetic screening to see what their risk is of having a baby with Down syndrome, Edwards syndrome or Patau syndrome- all conditions involving the child’s chromosomes.

Testing for all three syndromes is usually done with a finger stick for women 34 years of age and under, or a blood draw for women who will be 35 years of age or older at the time of delivery. The latter group is particularly at risk for these syndromes, and may opt for a diagnostic procedure instead of a screening test. Diagnostic tests can be done either in the first or second trimester, however these tests carry a risk of loss, so many women choose to do a non-invasive blood test first, and then proceed with further testing if their risk is found to be high.

Screening tests are offered early in the pregnancy to identify any risk as early as possible. Some women may choose not to do testing at all; however it is still recommended that the ultrasounds are done to evaluate the fetus and its environment for proper delivery planning.

Women with medical conditions such as high blood pressure, diabetes, and lupus are also considered high risk. These women can expect to receive multiple ultrasounds and consultations with the maternal-fetal medicine specialist as well. Sometimes pregnancy-related medical problems can occur later on in pregnancy, like gestational diabetes or gestational hypertension. Patients who develop these conditions will be referred to maternal-fetal medicine. Additionally, if a woman has as a history of spontaneous preterm births, is a smoker, is on opiates, has a short cervix, has the placenta covering her cervix, or whose ultrasound showed findings for the baby, a maternal-fetal medicine specialist will be involved and more frequent visits to the doctor will be required.

Some women experience anxiety when they are told that they should consult with the high-risk doctor, but rest assured the vast majority of patients who come to the maternal-fetal medicine clinic have good maternal and fetal outcomes. Tests are put in place to try and ensure the healthiest outcome possible for both mother and baby and are the only way to see if preventative treatments are needed. Proper prenatal care is a vital step along the way to a healthy pregnancy.

Catherine M. Herway, MD, FACOG is a Maternal-Fetal Medicine Specialist at Crystal Run Healthcare and is seeing patients in the practice's West Nyack facility.