A maternal fetal medicine specialist (MFM) is a doctor who, after completing four years of medical school and a four-year residency training in obstetrics and gynecology, completed an additional three years of fellowship training in maternal fetal medicine (sometimes called perinatology). To become a board-certified MFM, like our doctors are, a physician must finish this training and then pass oral and written board examinations in both obstetrics and gynecology and maternal fetal medicine.
The MFM fellowship training focuses on helping patients with high-risk pregnancies: addressing pregnancy complications, consulting regarding acute or chronic illnesses of the mother during pregnancy, and assisting with management when a pregnant patient requires hospitalization/ICU care. The fellowship also entails extensive ultrasound training focusing on diagnosis of fetal structural differences, genetic screening and testing, and performance of invasive prenatal diagnostic procedures such as amniocentesis, chorionic villus sampling (CVS), percutaneous umbilical blood sampling (PUBS), and intrauterine transfusion.
In short, the MFM works with the patient and her OB to screen for pregnancy complications, to provide additional resources for patients who are confronted with pregnancy complications, and to develop a specialized treatment plan to address medical issues that might arise with the mother or the baby during pregnancy.
Genetic counseling and consultation
Genetic screening with nuchal translucency and cell free fetal DNA screening
Genetic testing with chorionic villus sampling and/or amniocentesis
Targeted prenatal ultrasound in all trimesters
Percutaneous umbilical blood sampling
Pre- and post- conception consultation
Care for mothers requiring hospitalization in the intensive care unit during pregnancy, working with other subspecialists to maximize both mother and baby’s health
Assist in the management of acute and chronic maternal medical or surgical disorders during pregnancy
Make specialized delivery plans with obstetric and neonatal doctors to make sure babies with genetic and/or structural abnormalities known prior to delivery deliver in the facility best able to care for the infant
There are many reasons your obstetrician may refer you to our practice. Some of the more common include:
The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women be offered screening for genetic conditions that could affect their child. Prior to screening or testing in our office or after abnormal screening results in your OB’s office, meeting with our genetic counselor prior to your ultrasound and consultation with our doctors can help you make decisions. Our screening tests can look for chromosomal conditions like Down Syndrome and can also screen for increased risk for diseases like cystic fibrosis by testing the parents’ blood. Screening can be done through ultrasound examination and/or blood work. Genetic diagnostic testing can be done with chorionic villus sampling (CVS) or amniocentesis, and both procedures are available in our office.
High-resolution targeted ultrasound
There is a 3-5% baseline risk in the general population for structural abnormalities in newborn children. Some are mild and readily correctable like clubbed feet, but a small number can be serious enough to require surgery immediately after delivery for the best outcome. Detection of these conditions prior to delivery can improve outcomes for children when the condition is known and treatment plans are in place. The American College of Obstetricians and Gynecologists (ACOG) recommends that patients be offered a second trimester screening ultrasound to evaluate for any physical abnormalities. Some OB offices will perform this screen in their office and refer you to us if there is a concerning finding or if anatomy could not be seen well. Other OB doctors opt to send all their patients to us for high-resolution targeted ultrasound evaluation of anatomy.
Preterm birth remains one of the leading causes of childhood death and disability, complicating about 9% of all deliveries in the United States. Many women who experience a pregnancy complicated by preterm birth will have no risk factors. In women who do have known risk factors, the most predictive of which is a prior spontaneous preterm birth, consultation in our office for management strategies to decrease recurrence risk and for serial ultrasounds to assess cervical length can help to decrease risk of recurrence.
Serial growth assessments
Some patients will have children who are at higher risk for over- or under- growth based on maternal health issues like diabetes, hypertension, and autoimmune disease. Other patients have babies who are at higher risk because of multiple gestation (twins or triplets) or because the patient had a prior child who was growth restricted/small for gestational age. Patients with these indications may need to be seen more often to measure the baby’s/babies’ estimated size by ultrasound to detect developing issues early.
Similarly, babies at risk for growth issues based on maternal and/or fetal conditions may benefit from weekly fetal testing during the third trimester. The testing that we offer in our office is called a biophysical profile (BPP). It consists of monitoring the baby’s heartbeat with a printout of the rhythm and an ultrasound that assesses fluid around the baby and certain fetal behaviors and movements during the ultrasound. The BPP is a tool that helps our doctors assess fetal well-being, and it is used for all patients seen in our office at or after their 32nd week of pregnancy.