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The medical team at High Risk Pregnancy Consultants works diligently to stay abreast of the latest high-risk pregnancy, and obstetrics and gynecology news. With frequent visits to the Society of Maternal Fetal MedicineAmerican College of Obstetricians and Gynecologists (ACOG), Centers for Disease Control and Prevention, Women’s Health and US Department of Health and Human Services websites, it is a bit easier to correctly answer the many questions our wonderful patients ask.

Please reference the list of frequently asked questions (FAQs) below for helpful information regarding your obstetric, gynecologic and high-risk pregnancy care—ranging from the role of a maternal-fetal medicine specialist to who is referred to a maternal-fetal specialist and from amniocentesis to CVS.

What is a Maternal-Fetal Medicine Specialist?

Per the Society of Maternal Fetal Medicine, A Maternal-Fetal Medicine sub-specialist is an individual who has completed two to three years of Maternal-Fetal Medicine fellowship after completing four years of Obstetrics and Gynecology residency upon graduation from Medical School. Fellowship training provides additional education and practical experience to gain special competence in various obstetrical, medical, and surgical complications of pregnancy. By virtue of this training and technical proficiency, the Maternal-Fetal Medicine sub-specialist provides care or consultation for both mother and fetus (unborn baby) in a complicated pregnancy. In addition, he/she provides education and research concerning the most recent approaches to the diagnosis and treatment of obstetrical problems. He/she thus promotes awareness of the diagnostic and therapeutic techniques for optimal management of these complicated pregnancies.

Who is referred to a Maternal-Fetal Medicine Specialist?

Per the Society of Maternal Fetal Medicine, the following are candidates for referral and evaluation by a Maternal Fetal Medicine Specialist. Patients undergoing diagnostic or therapeutic procedures during pregnancy, such as:

  • Comprehensive ultrasound
  • Chorionic villus sampling
  • Genetic amniocentesis
  • Fetal treatment

Women with medical or surgical disorders, such as women with:

  • Heart disease
  • High blood pressure
  • Preeclampsia (toxemia)
  • Diabetes or other endocrine disorders
  • Kidney or gastrointestinal disease
  • Infectious diseases
  • Respiratory problems like asthma or cystic fibrosis
  • Seizure disorders
  • Clotting or bleeding disorders
  • Cancer or a history of cancer
  • History of an organ transplant
  • Lupus or autoimmune disorders
  • A weak cervix

Healthy women whose pregnancy is at increased risk for problems, such as:

  • An abnormal AFP (alpha fetoprotein) blood test in the current pregnancy
  • Twins, triplets or more
  • Recurrent pre-term labor or early delivery in the past
  • Premature rupture of membranes in the past
  • Recurrent pregnancy loss
  • Suspected fetal growth restriction (baby not growing enough)
  • Infections in pregnancy including HIV, Hepatitis, Cytomegalovirus

And women who have a baby felt to be at risk for birth defects due to:

  • Mother’s age over 35
  • Previous child with birth defects
  • Family history of a child with birth defects or genetic disorders
  • Suspicion of birth defects on an ultrasound in the current pregnancy
  • Suspicion of birth defects due to blood tests in pregnancy
  • Exposure to medications that may cause birth defects such as anti-seizure medications or the blood thinner Coumadin

What is an Amniocentesis?

Amniocentesis is a test done during pregnancy to get information about the fetus. The most common reason for amniocentesis is to determine for sure whether a fetus has certain genetic problems, such as Down syndrome. This test is usually done between 15 and 17 weeks of pregnancy.

The first step in the procedure is to perform an ultrasound of the uterus. With ultrasound, the doctor can see the fetus, amniotic fluid and the placenta.

After cleaning the abdomen, the doctor inserts a needle and uses the ultrasound picture to guide the needle safely into a pocket of amniotic fluid. The doctor removes a small amount of fluid (about one ounce). The needle stick is mildly uncomfortable or crampy.

Immediately after the procedure, some women have mild cramping, a small amount of vaginal bleeding, and a small amount of amniotic fluid leaking from the vagina. This should all resolve quickly.

However, you should call your primary obstetrician or present to the hospital where you plan to deliver to be evaluated in their Triage area if:

  • You continue to leak fluid or bleed
  • You have severe cramping lasting several hours
  • You have a fever (temperature higher than 100.4ºF or 38ºC) after the amniocentesis

How to prep for an Amniocentesis?

  • You can eat prior to the amniocentesis.
  • You can have family members with you in the room during the procedure, which usually only takes about 5 minutes.
  • You can work at a sitting job on the day of your amniocentesis, but if you have an active job, we are happy to provide you with a work excuse for that day so that you can take it easy.

Most labs are able to provide results within 7 to 14 days. Some results can be as rapid as 2-3 days, some results can take up to 4-6 weeks.  We forward the results to your primary obstetrician, and also directly notify the patient if the resutls are abnormal. 

Amniocentesis involves certain risks.

Complications can include: 

  • Leakage of amniotic fluid
  • Injury to the fetus
  • Pregnancy loss
  • Infection

What is Chorionic Villus Sampling (CVS)?

Chorionic villus sampling (CVS) is a procedure that may be performed during pregnancy to diagnose certain genetic or chromosomal disorders. CVS involves having a biopsy of the developing placenta. The chorionic villi are the tiny units that make up the placenta and have the same chromosomes as the fetus.

CVS can test for conditions such as Down syndrome, Tay Sachs disease, and cystic fibrosis. It is generally performed during the first trimester of pregnancy, at 10 to 12 weeks, and the results are available within a few days.

Amniocentesis can provide similar information, but it can only be done later in pregnancy (typically at 16 to 17 weeks).

Your health care provider may recommend CVS if:

You have a family history of a genetic disorder, such as:

  • Down syndrome
  • Tay Sachs disease
  • Cystic fibrosis

Having a family history increases the chances of inheriting the condition. Prenatal testing (blood tests or ultrasound) shows that your fetus is at increased risk of having a genetic disorder.

Should you have a CVS or amniocentesis? 

Meeting with our genetic counselor will help answer this question. Due to this, we require that you meet with our genetic counselor prior to consulting with the maternal-fetal medicine specialist. CVS provides results as soon as possible in the first trimester. However, the procedure has a slightly higher risk of miscarriage compared to amniocentesis.

You may want to know if your fetus has a genetic disorder early in your pregnancy for several reasons:

  • Your pregnancy may still be relatively private, not known by family, friends and acquaintances.
  • If you would consider terminating your pregnancy based on the results of testing, pregnancy termination is somewhat safer early in pregnancy.

There are two ways to perform CVS:

  • Through the cervix (called transcervical)
  • Through the abdomen (transabdominal)

The choice is based on where the placenta is attached to the uterus. With both methods, the procedure is performed while having an ultrasound.

Transcervical CVS

In the transcervical CVS technique, the physician inserts a small tube through the cervix into the placenta.  This is done while ultrasound guides the physician.

Transabdominal CVS

In the transabdominal CVS technique, the physician inserts a needle through the abdomen into the placenta.  This is also done with ultrasound, to guide the physician.

The physician can usually obtain enough placental tissue the first time he or she inserts the needle or tube into the placenta. However, if there is not enough tissue, the physician may need to try again.

How to prep for Chorionic villus sampling (CVS)?

  • You can eat prior to the CVS. 
  • You can have family members with you in the room during the procedure, which usually only takes about 5 minutes. 
  • You can work at a sitting job on the day of your CVS, but if you have an active job, we are happy to provide you with a work excuse for that day so that you can take it easy. 

Most labs are able to provide results within 7 to 14 days.  Some results can be as rapid as 2-3 days, some results can take up to 4-6 weeks. We forward the results to your primary obstetrician, and also directly notify the patient if the resutls are abnormal. 

CVS involves certain risks.

Complications can include: 

  • Leakage of amniotic fluid
  • Injury to the fetus
  • Pregnancy loss
  • Infection

If you feel you are having any problems after your CVS, do not call our office. Rather, notify your obstetrician and present to the hospital where you plan to deliver to be evaluated in their Triage area. 

Should I have screening for Down Syndrome in my pregnancy?

The decision to have screening is a personal one. Meeting with our genetic counselor can help clarify this issue and can be arranged by our office prior to your visit. The decision to have this screening should be made by the mother after she considers the information from her doctor, and discussing this issue with her husband or significant other. If you are still unsure about having screening in the pregnancy, consider meeting with our Genetic Counselor.  She can discuss the issues and ramifications of having this testing in detail. 

Is ultrasound safe in pregnancy?

According to the AIUM, or American Institute of Ultrasound in Medicine, “Diagnostic ultrasound studies of the fetus are generally considered safe during pregnancy. This diagnostic procedure should be performed only when there is a valid medical indication, and the lowest possible ultrasonic exposure setting should be used to gain the necessary diagnostic information under the as low as reasonably achievable (ALARA) principle.” 

The BMUS, or British Medical Ultrasound Society, states “Ultrasound was first used in medical imaging fifty years ago, and today accounts for about a quarter of all imaging procedures…Numerous scientific studies have provided reassuring evidence that ultrasound imaging is not harmful to adults, children, or the human fetus or embryo. However, it is known that some modern ultrasound scanners are capable of producing subtle heating and other effects inside the human body…Hence, the British Medical Ultrasound Society considers ultrasound imaging to be safe when it is performed prudently, for a clear medical purpose, by properly trained professionals, using well maintained equipment.” 

At High Risk Pregnancy Consultants, we adhere to the recommendation of using the ultrasound for diagnostic information, and monitor the ultrasound frequency output of our machines to keep the amount of ultrasound energy as low and safe as possible for the safety of both mother and unborn baby.