The maternal-fetal medicine subspecialty requires three additional years of education beyond regular obstetrics. Additional knowledge is needed because the focus is on high-risk pregnancies. High-risk pregnancies are those in which the health or life of the woman or fetus is at risk. There are a number of risks that a pregnant woman can face that would make her pregnancy high risk.
These include chronic problems such as:
- High blood pressure which can damage the kidneys and lead to increased risk of a low birth weight baby or preeclampsia (a blood pressure problem that arises after 20 weeks of pregnancy)
- Diabetes as high blood sugar during pregnancy can cause macrosomia (large baby) and jaundice
- Kidney disease which can put a woman in danger of miscarriage
- Autoimmune diseases such as lupus or rheumatoid arthritis that are exacerbated by pregnancy
Another factor that increases the risks of pregnancy is age. The older a woman is the more risks she faces. Once a woman is over 25 years of age she is more likely to need a cesarean and face complications during labour such as excessive bleeding or prolonged labour. In addition, the risk of the baby having Down Syndrome is increased. For example, the chances of Down Syndrome increase substantially at the age of 35 exponentially after 35. increases at the age of 35. There is also increased risk of miscarriage as a woman ages. A woman over 35 faces increased the risk of high blood pressure, pregnancy-induced diabetes, placenta previa (requires cesarean), premature birth, multiples, and low birth weight. All obstetrician & specialist in Maternal Fetal Medicine know that every woman’s family and baby is different, they care for you during your pregnancy will be complete, whether or not it’s a straightforward pregnancy.
A final high-risk situation is multiples. As woman are having babies at later ages and increasingly using advanced fertility techniques, multiples have become more common. The risks involved with multiples include preeclampsia, gestational diabetes, and placental abruption. In addition, the babies are often preterm.
Complication from preterm birth (babies are born before 37 weeks) occurs because the baby is not fully developed and ready to live outside the mother’s womb. Their organs such as the lungs, brain, and liver have not matured enough to survive without medical intervention. The mother may need to be treated with bed rest and medication to prevent birth while treatments to mature the baby’s organs more quickly can be administered. After birth, they often require stays in the ICU due to jaundice, respiratory distress, and reflex underdevelopment. Some of these babies cannot breastfeed as the sucking mechanism did not fully develop. They have low birth weights (less than 5.5 lbs.). Those babies born before 32 weeks, can have developmental delays.
Other factors that qualify a woman for high risk are previous issues with pregnancy and obesity.
In recent years, maternal-fetal medicine has begun fixing birth defects discovered in utero. These birth defects include twin-twin transfusion syndrome, neural tube defects, and congenital heart disease.
Statistics Related to High-Risk Pregnancies
- 6-8% of all pregnancies are considered high risk
- 9.8% result in premature births
- 3-5% suffer from preeclampsia
- 2-10% have gestational diabetes
- 8.2% have low birth weight
- Average birth rate based on gestational age
- 7.5 lbs at 40 weeks
- 5.5 lbs at 35 weeks
- 3.5 lbs at 32 weeks
- 2.5 lbs at 28 weeks
- 1.5 lbs at 24 weeks
- Chance of Down Syndrome as woman ages:
- 1 in 1,1250 at the age of 25
- 1 in 400 at the age of 35
- 1 in 30 at the age of 45.
- Number of multiple births
- 131,723 twin births
- 3755 triplet births
- 217 quadruplet
- 31 quintuplets and higher
- Live births from high-risk situations
- 33.4 per 1000 for twins
- 101.4 per 100,000 for triplets or more
Maternal-fetal medicine provides the necessary treatments for these high-risk pregnancies and the care provided can prevent some of these issues and help spot before causing problems early so they can be corrected. Thus, preventative medicine is the best place to start with prenatal care visits, ultrasounds, tests, and more frequent monitoring.
Tests specific to the high-risk situation can be used including nonstress test, biophysical profile high-resolution ultrasound, amniocentesis, and chorionic villus sampling (CVS). These tests can indicate if a problem is developing with the mother or the baby. Medications can be used to treat pregnancy-related complications such as pravastatin for preeclampsia, anemia with iron and folic acid, and insulin for gestational diabetes.
Maternal-fetal medicine specialist can prevent or halt preterm labour with bed rest, hydration, and medications tocolytic medications. Medication in the tocolytic family prevent preterm birth. Tocolytics such as terbutaline, magnesium sulfate, and nifedipine prevent contractions. This gives the physician time to intervene with the baby in utero with medications that help the baby’s organs mature faster. By using medications such as steroids for organ development, the baby can be born healthier. In utero interventions can correct birth defects that affect organs by repairing the damage before the baby is born. Fetal surgery, fetoscopic surgery can repair vessels. Fetal shunting removes excess fluids.
Some Interesting Facts
Over four million live births a year with approximately 140,000 multiples births.
Due to fertility treatments, multiple births have risen from 2% prior to the nineties and advent of fertility treatments to 3.5% in 2015.
The birth rate for women over 40 is at the highest level ever seen.
Birth defects occur in 3% or babies and are the source of 20% of infant deaths.
The Latin word for obstetrics is obstetrīcus which means “to stand.”
Snoring during pregnancy has an increased correlation with the necessity of cesarean birth and low birth weight
After 28 weeks, 90% of all babies can survive.
In vitro fertilization uses a vaginal ultrasound to detect a heartbeat as early as 6 weeks.
In 1997, the first in utero spinal cord repair surgery was done by doctors at Vanderbilt University.
The primary goal in a high-risk pregnancy is a happy and healthy mother and baby. With early and frequent monitoring, prenatal interventions, and advanced medical interventions, a maternal-fetal medicine specialist can bring a high-risk pregnancy to a successful conclusion.Read more