Maternal Fetal Medicine (MFM) is a medical subspecialty that focuses on the care of pregnant patients and their unborn babies (fetuses). It involves the management of high-risk pregnancies, which can be caused by a variety of factors such as maternal medical conditions, fetal abnormalities, or complications of pregnancy. The goal of MFM is to optimize the health and well being of both the mother and the baby. MFM specialists are obstetricians/gynecologists (OB/GYNs) who have undergone an additional 3 years of training in the diagnosis, management and treatment of high-risk pregnancies. They work closely with other healthcare professionals, such as genetic counselors, neonatologists, and pediatric cardiologists, to provide comprehensive care for the patient and fetus. MFM specialists use various diagnostic techniques to assess the health of the fetus, including ultrasound, fetal echocardiography, and amniocentesis. They also monitor the patient’s health and treat any medical conditions that may affect the pregnancy, such as diabetes, hypertension, or autoimmune disorders. Overall, Maternal Fetal Medicine physicians have a specialized knowledge and skill set that enables them to provide comprehensive, expert care to high-risk pregnant patients. While general obstetricians may have some experience in managing high-risk pregnancies, MFM specialists are uniquely trained and equipped to manage the most complex and challenging cases.
There are several unique aspects of MFM that set it apart from other areas of obstetrics and gynecology:
- Advanced diagnostic tools: MFM specialists use advanced diagnostic tools to assess the health of the fetus and diagnose any fetal abnormalities or conditions. This may include genetic testing, fetal echocardiography, and other specialized tests.
- Specialized treatments: MFM specialists are familiar with a range of specialized treatments and interventions that may be used to manage high-risk pregnancies. These may include fetal surgery, medication management, and other treatments to optimize the health of the patient and the baby.
- Multidisciplinary care: MFM specialists work closely with other healthcare providers, including obstetricians, neonatologists, genetic counselors, and other specialists to provide comprehensive, coordinated care to high-risk pregnant women and their unborn babies.
- Management of maternal medical conditions: MFM specialists have expertise in managing pre-existing maternal medical conditions, such as diabetes, hypertension, or autoimmune disorders, during pregnancy to minimize the risks to the mother and baby.
- Emotional support and counseling: MFM specialists provide counseling and emotional support to help patients and their families cope with the unique challenges of a high-risk pregnancy.
- Fetal therapy: In some cases, MFM specialists may provide/coordinate fetal therapy to treat certain fetal conditions while the baby is still in the womb. This may include fetal surgery, transfusions, or other interventions.
Your first maternal fetal medicine (MFM) appointment will involve a comprehensive medical evaluation and a review of your medical history. Here is what you can expect during your first MFM appointment:
- Medical history review: Your MFM specialist will ask you about your medical history, including any previous pregnancies, surgeries, medical conditions, and medications. We will also ask about your family history or medical conditions, including genetic conditions.
- Ultrasound: Depending on the reason for your referral, your MFM ultrasound technician will likely perform an ultrasound to evaluate the baby’s growth and development. The MFM physician will review and interpret the ultrasound images and discuss the results with you.
- Blood tests and other diagnostic tests: Your MFM specialist may order or recommend blood tests, genetic testing or other diagnostic tests.
- Development of a care plan: Based on the results of the evaluation and any diagnostic tests, your MFM specialist will develop a care plan that is tailored to your individual needs. This may include recommendations for ongoing monitoring, specialized treatments, or interventions to optimize the health of the patient and baby.
- Counseling and emotional support: Your MFM specialist will provide counseling and emotional support to help you and your family cope with the unique challenges of a high-risk pregnancy.
Your first MFM appointment is an opportunity to receive specialized care and develop a comprehensive care plan that is tailored to your individual needs. Your MFM specialist will work closely with you and your healthcare team to ensure that you receive the best possible care throughout your pregnancy.
A level II ultrasound, also known as a targeted or detailed ultrasound, is a specialized ultrasound that is performed during pregnancy to evaluate the health and development of the fetus in more detail than a standard ultrasound. This type of ultrasound is performed by a registered diagnostic medical sonographer with specialized training in high-risk pregnancy. The ultrasound is interpreted by a Maternal Fetal Medicine specialist.
During a level II ultrasound, high-frequency sound waves are used to create detailed images of the fetus and surrounding structures. The ultrasound may be performed transabdominally or transvaginally, and may take up to an hour or more to complete.
A level II ultrasound can be used to evaluate various aspects of fetal developments and well-being, including:
- Fetal anatomy: The exam can evaluate the structure and function of the fetal organs.
- Fetal growth: The exam can measure the size and weight of the fetus, which can help determine whether the fetus is growing appropriately for its gestational age.
- Placental function: The exam can evaluate the position and function of the placenta, which can impact fetal growth and well-being.
- Amniotic fluid volume: The exam can measure the amount of amniotic fluid surrounding the fetus, which can provide important information about fetal well-being.
- Fetal movements: the exam can observe fetal movements, which can provide important information about fetal well-being.
A level II ultrasound is an important tool for evaluating fetal development and well-being during pregnancy. It is often recommended for pregnant patients who are at high risk for abnormalities or who have abnormalities detected during a routine prenatal ultrasound. The results of the level II ultrasound can help guide prenatal counseling and planning for delivery and postnatal care.
A fetal echocardiogram is a specialized ultrasound that is performed during pregnancy to evaluate the structure and function of the fetal heart. This type of ultrasound is typically performed by a specially trained sonographer. During a fetal echocardiogram, high-frequency sound waves are used to create detailed images of the fetal heart. The ultrasound is performed transabdominally.
A fetal echocardiogram can be used to evaluate various aspects of the fetal heart, including:
- Heart structure: The exam can evaluate the structure of the fetal heart and identify any abnormalities, such as holes in the heart, valve defects, or abnormal blood flow patterns.
- Heart function: The exam can evaluate the function of the fetal heart, including heart rate, rhythm, and contraction strength.
- Blood flow: The exam can evaluate blood flow to and from the fetal heart, including the presence of any blockages or narrowing in the blood vessels.
- Diagnosis: The exam can help diagnose fetal heart defects and other cardiac abnormalities.
Fetal echocardiogram is an important tool for evaluating the fetal heart and detecting any potential cardiac abnormalities. It is often recommended for pregnant patients who have a family history of congenital heart disease, have certain medical conditions, or have abnormalities detected during a routine prenatal ultrasound. The results of the fetal echocardiogram can help guide prenatal counseling and planning for delivery and postnatal care.
An amniocentesis is a medical procedure that is performed during pregnancy to obtain a sample of amniotic fluid from around the developing fetus. This procedure is typically performed between 15 and 22 weeks of pregnancy and is used to evaluate the genetic and chromosomal health of the fetus.
During an amniocentesis, the MFM specialist will use ultrasound guidance to insert a thin needle through the patient’s abdomen and into the amniotic sac. A small amount of amniotic fluid will be withdrawn through the needle and sent to the laboratory for testing.
Amniocentesis can be used to evaluate various aspects of fetal health, including:
- Chromosomal abnormalities: The procedure can test for chromosomal abnormalities such as Down syndrome, Trisomy 18, and Trisomy 13.
- Genetic disorders: The procedure can test for certain genetic disorders or single gene disorders
- Fetal infection: In some cases the amniotic fluid can be tested for evidence of fetal viral infections.
Amniocentesis is a useful tool for evaluating the genetic and chromosomal health of the fetus. However, it is an invasive procedure that carries a small risk of complications, such as miscarriage. The decision to undergo amniocentesis should be made after careful consideration and discussion with a genetic counselor and maternal fetal medicine physician.
A McDonald cervical cerclage is a surgical procedure that is performed during pregnancy to help prevent premature delivery in women who are at risk for cervical insufficiency. The procedure involves placing a stitch around the cervix to keep it closed and prevent it from opening prematurely.
The procedure can be performed around 12-14 weeks of pregnancy for a patient with a history of cervical insufficiency or later in pregnancy if a short or dilated cervix is noted on ultrasound The procedure is typically performed as an outpatient procedure under regional anesthesia.
The cerclage stitch is removed around 37 weeks of pregnancy to allow for a normal vaginal delivery. In some cases, the stitch may need to be removed earlier if there are concerns about fetal well-being or signs of labor.
A perinatal genetic counselor is a healthcare professional who specializes in providing information and counseling to individuals and families who may be at risk of having a child with a genetic disorder or birth defect.
The role of a perinatal genetic counselor is to help patients understand the potential genetic risks associated with their pregnancy, and to provide information and guidance about available testing and screening options. They will also help patients make informed decisions about their pregnancy based on the information available.
Perinatal genetic counselors work closely with maternal fetal medicine specialists, as well as medical geneticists, and other healthcare professionals, to provide coordinated care to high-risk pregnancies.
During a counseling session, a perinatal genetic counselor will typically review the patient’s medical and family history, discuss the potential genetic risks associated with the pregnancy, and provide information about available testing and screening options. They may also help the patient understand the results of any genetic testing that has been performed, and provide guidance and support as needed throughout the pregnancy and beyond.
A perinatal sonographer is a specialized medical professional who uses ultrasound imaging technology to examine and monitor the health of fetuses during pregnancy by evaluating the growth, development, and the overall health of the fetus.
During an ultrasound exam, a perinatal sonographer will use a transducer to emit high-frequency sound waves through the patient’s abdomen, which bounce off the fetus and surrounding structures to create images that can be viewed on a monitor. The sonographer will carefully assess these images and document the findings for the MFM physician.
Perinatal sonographers perform a variety of specialized ultrasound exams, including level II ultrasounds, fetal echocardiograms, and cervical length measurements.
A maternal fetal medicine (MFM) registered nurse (RN) in an ultrasound clinic is a specialized healthcare professional who works closely with perinatal specialists, including maternal fetal medicine physicians and perinatal sonographers, to provide high-quality care to patients with high-risk pregnancies.
The role of an MFM RN includes:
- Patient Assessment: The MFM RN may assess patients’ medical history, perform physical examinations and monitor vital signs to help identify any potential risks or complications related to the pregnancy.
- Patient Education: The MFM RN will provide education and support to patients about ultrasound procedures, fetal monitoring, and other aspects of perinatal care.
- Coordination of Care: The MFM RN will help to coordinate care as it pertains to communication with the patients’ primary obstetrician, other Pediatric subspecialist appointments.
- Documentation: The MFM RN will prepare consultations and prepare patient charts for subsequent visits.
- Support for Patients and Families: The MFM RN may provide emotional support to patients and their families, answering questions and providing reassurance about the pregnancy and the care being provided.
The role of an MFM RN in an ultrasound clinic is to support the delivery of high-quality, patient-centered care to pregnant women with high-risk pregnancies, working collaboratively with a team of perinatal specialists to ensure the best possible outcomes for both mother and baby.