Maternal Fetal Medicine (MFM), or Perinatology, is the subspecialty of obstetrics & gynecology (OB/Gyn) that cares for high risk families.
In residency, the MFM clinic was simply called hi-risk OB or OB complications (it was called OB comp clinic). Perinatologists have a passion for assessment and management of risk. Though we always wish low risk for our patients, because that is most probable to result in healthy outcome for mom and baby, unfortunately that luxury is not always the case. That’s what we’re here for.
At any rate, Maternal Fetal Medicine Specialists ( also known as Perinatologists) care for women and their unborn babies (fetuses) who are experiencing some sort of circumstance that places the pregnancy outcome at higher risk.
The list of indications for which families might benefit from seeing MFM prior to or during their pregnancy is a long one.
During early pregnancy, or for some disorders preferably in the preconception period, some maternal disorders which may affect maternal and fetal health, and are very much amenable to effective treatment, are:
- Medication use of any kind that might affect the fetus
- Diabetes, both hypo and hyper thyroidism, obesity & history of bariatric surgery
- Autoimmune disorders such as lupus, rheumatoid arthritis, antiphospholipid syndrome (APS), or myasthenia gravis
- Connective tissue diseases such as Marfan syndrome and Ehlers Danlos syndrome (EDS), with maternal risk of cardiac issues
- Mental health issues such as depression, anxiety, bipolar, personality disorder
- Substance use disorders including smoking, cannabis, alcohol, methamphetamine & opiates
- Cardiopulmonary disease including maternal congenital heart disease (a heart defect the mother is born with), hypertension, arrhythmia and history of heart attack (myocardial infarction, MI)
- Gastrointestinal disorders such as ulcerative colitis, Crohn’s disease, celiac disease
- History of deep venous thrombosis (DVT) or pulmonary embolus (PE), thrombophilia (Leiden (factor V), prothrombin 20210 (factor II), protein C, protein S, etc.)
- Neurologic disorders such as seizures/epilepsy, arteriovenous malformation (AVM), multiple sclerosis (MS), idiopathic intracranial hypertension (IIH, pseudotumor cerebri), transient ischemic attack (TIA) or stroke
- History of trauma, cancer, and transplant
Some families should be seen by MFM for current findings or history of certain genetic issues with risk of recurrence such as:
- Abnormal genetic screening (integrated screen, sequential screen, quad screen, non-invasive prenatal testing) in the current pregnancy
- Advanced parental age (technically maternal age 35 & above, paternal age 40 & above)
- Prior pregnancy or 1st degree family member (sibling, child, or parent) with chromosome disorders such as Down syndrome (trisomy 21), trisomy 13 & 18, deletions and other abnormalities
- 1st degree relative with congenital heart disease
- Other heritable diseases such as sickle cell, spinal muscular atrophy (SMA), fragile X, cystic fibrosis (CF), EDS, phenylketonuria (PKU)
- Other congenital malformations (birth defects), such as heart defects, neural tube defects (spina bifida & anencephaly), abdominal wall defects (gastroschisis & omphalocele), and many others
Women with history of prior pregnancy complications, all of which have substantial risk of recurrence, should be seen by MFM with an eye toward decreasing risk in ensuing pregnancy:
- Recurrent pregnancy loss (miscarriage)
- Fetal demise (death in utero)
- Preterm delivery
- Cervical insufficiency (cervical incompetence)
- Preeclampsia, particularly with severe features such as eclampsia (seizures), HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets, renal failure & nephrotic syndrome
- Maternal fetal immune compatibility disorders such as neonatal alloimmune thrombocytopenia (NAIT) and red cell isoimmunization (red cell incompatibility, Rh disease)
Likewise, mothers with some of the previously mentioned problems arising in their current pregnancy might benefit from having MFM involved in the comanagement of their complications:
- Preterm labor & premature rupture of membranes
- Cervical insufficiency
- Bleeding, most often from abruption or previa
- Maternal medical & surgical problems, including but limited to:
- Gestational or previously unrecognized diabetes, hypertension & preeclampsia
- Substance use disorders
- Surgical issues, including appendicitis, cholelithiasis (gallbladder disease) & malignancy
- Current trauma or past history of trauma
- Critical care of obstetric patients (patients in ICU, CCU or SICU for any reason)
- DVT, PE, thrombophilia, & APS
- Advanced maternal age
- Abnormal genetic screening
- Family history of genetic issues
- Infectious diseases
- Treatment and prevention of cytomegalovirus (CMV)
- Human parvovirus B-19 (Fifth’s disease, slapped cheek disease of children)
- Zika virus
- Human immunodeficiency virus (HIV, AIDS)
- Hepatitis B, hepatitis C & hepatitis D
- Coronavirus (COVID-19, Sars-Cov2)
- Multiple gestation (twins, triplets, etc.), including shared placenta problems (monochorionic multiples, monoamniotic multiples)
- Congenital malformations, birth defects (neural tube defects, abdominal wall defects such as diaphragmatic hernia, heart defects, genitourinary defects (pyelectasis, hydronephrosis, lower urinary tract obstruction))
- Fetal growth abnormalities (fetal growth restriction, skeletal dysplasia, macrosomia)
- Amniotic fluid disorders (polyhydramnios, oligohydramnios, preterm rupture of membranes)
- Women’s rights, Jehovah’s Witness or other spiritual, cultural or personal unique sensibilities in pregnancy
If your history or complication is on this list, you might want to ask your obstetrician if a maternal fetal medicine consultation would be valuable. Our team can add to the quality of any patient’s pregnancy.
As you can see, this is a long list, which is by no means all inclusive. We could write a page for you about any one of these problems.
The point here is that MFM is readily available in Cedar Rapids. In fact, the full spectrum of prepregnancy, antenatal and peripartum management is right here where you need it, when you need it.
Though of course we are collegial and collaborative with our excellent MFM colleagues at the University of Iowa, and we readily transfer patients to their team when appropriate & necessary, that is rarely needed.
Our team in Cedar Rapids is perfectly configured to expertly contend with most all maternal and fetal problems, including premature birth at any gestational age. Ask your obstetric provider if we should be on your team.