Pregnancy is an exciting time, but it can also be stressful. Since certain complications during pregnancy can unexpectedly arise at anytime, a comprehensive pregnancy care provided by expert specialist, known as MFM (Maternal-Fetal Medicine) is vital. The sooner in pregnancy good care begins, the better for the health of both mothers and their babies.
Get to know MFM
Maternal-Fetal Medicine or MFM, also known as perinatology, is a branch of medicine aiming at managing health concerns of the mother and fetus prior to, during and shortly after pregnancy. MFM specialists are subspecialized within the field of obstetrics. Their training typically includes residency and fellowship in obstetrics and gynecology. MFM specialists take comprehensive care of pregnant women and their unborn babies prior to and during pregnancy. They usually conduct pregnancy risk assessment and prenatal tests as well as provide treatments including surgeries, if necessary. MFM specialists act as a consultant during lower-risk pregnancies and as the primary obstetrician in high-risk pregnancies with serious pregnancy-related complications. After birth, MFM specialists may work closely with pediatricians or neonatologists to manage post-delivery complications.
Scope of services
During pregnancy, a variety of complications may arise at any stage. Depending on the severity of the complications, MFM specialists attend to patients who fall within certain levels of maternal care. These levels correspond to health risks during pregnancy for the baby, mother, or both. The scope of practice of MFM specialists include:
- Providing a comprehensive plan before and during pregnancy as well as during and post delivery care.
- Arranging state-of-the-art management and antenatal care of high-risk pregnancies.
- Planning and providing necessary treatments if the fetuses are suspected to develop forms of abnormalities.
- Evaluating health status of the fetuses and detecting signs of disability or improper growth and development.
- Screening and diagnosis of fetal illness or abnormalities.
- Detecting genetic abnormalities of the fetuses by conducting a wide range of tests such as amniocentesis –a procedure in which amniotic fluid is removed from the uterus for testing, chorionic villous sampling (CVS) –a sample of chorionic villi is removed from the placenta for testing and cordocentesis which is percutaneous umbilical blood sampling.
- Providing effective and safe treatments to the mothers who are at risk for pregnancy-related complications e.g. preterm labor, preeclampsia and twin or triplet pregnancies.
- Providing effective and safe treatments to the fetuses with complications e.g. hydrops fetalis (severe swelling or edema in an unborn baby), abnormal heartbeat, chromosomal abnormalities, maternal disease, infections and growth restriction.
- Providing labor and delivery care as well as postpartum care.
- Terminating pregnancies if medically indicated.
High-risk pregnancy
A high-risk pregnancy threatens the health or life of the mothers and fetuses. It often requires specialized care from specially trained MFM specialists. A high-risk pregnancy can be the result of certain medical conditions present before pregnancy. In other cases, medical conditions might develop during pregnancy for either mothers or unborn babies or both, causing a pregnancy to become high risk. Specific mother’s conditions that potentially contribute to a high-risk pregnancy include:
- Mothers aged over 35: Advanced maternal age increases risks of complications during pregnancy;
- Mothers aged under 18: Women under the age of 18 have a significantly higher risk of serious medical complications related to pregnancy;
- Multiple pregnancy e.g. twin or triplet pregnancies: Risks significantly rise if two separate eggs (ova) are fertilized by two separate sperm. In such a case, complications might include abnormal circulation between two fetuses and unequal fetal growth and development;
- Mothers who have certain underlying diseases e.g. diabetes, hypertension, autoimmune disease e.g. systemic lupus erythematosus (SLE), chronic kidney disease, seizure, asthma and cancer;
- Mothers who are Rh-negative with isoimmunization: If mother with Rh-negative blood is pregnant with a baby that has Rh-positive blood, it can cause a problem if the baby’s blood enters the mother’s blood flow. The Rh-positive blood from the baby makes the mother’s body to create antibodies which is called isoimmunization. Complications caused by Rh incompatibility include brain damage, seizure, fluid buildup and swelling in the baby, resulting in impaired development;
- Mothers with infectious diseases e.g. hepatitis and sexual transmitted diseases;
- Mothers who have previous history of taking certain medicines or chemical substances that affect the growth of fetus;
- Mothers who have short cervical length that potentially induces preterm labor;
- Mothers who have had a history of pregnancy-related complications such as miscarriages and an abnormal placenta position;
- Mothers who gave birth prematurely in the last pregnancy or had multiple premature births;
- Mothers who gave birth to the baby who had impaired growth and development during fetal phase;
- Mothers who gave birth to the baby who had low birth weight or intrauterine growth restriction (IUGR) –a condition in which an unborn baby is smaller than regular size because an abnormal rate of growth inside the womb;
- Mothers who gave birth with congenital defects;
- Mothers who have genetic disorders e.g. thalassemia; and
- Mothers who develop preeclampsia –a pregnancy complication characterized by high blood pressure and signs of damages to other organ systems, most often the liver and kidneys.
Pregnancy screening with MFM specialists
During the entire period of pregnancy, pregnant women are highly suggested to receive comprehensive screening program conducted by MFM specialists at least 3 times, including:
1st screening: during 11 – 14 weeks
The purpose is to evaluate the growth and development of the fetuses. If abnormalities are detected, immediate medical treatments can be promptly provided, thus reducing severity.
2nd screening during 18 – 23 weeks
The screening aims at detecting any abnormal systems and structures of the fetuses. If there is no abnormality is found, it considerably indicates that fetus has a proper growth and development. Tests might include
chorionic villous sampling (CVS) –a sample of chorionic villi is removed from the placenta for testing, gynecological examination of the mothers and the measurement of the cervical length in order to identify the risks of preterm labor.
3rd screening during 32-36 weeks
The purpose of screening at late stage of pregnancy is to evaluate the fetal growth and overall development. The screening verifies the position of the placenta and the amount of amniotic fluid –protective fluid that surrounds and protects fetus while it is growing in the uterus. Although the abnormalities in the late stage of pregnancy could be detected, it rarely happens. If the complications can be caught early, appropriate treatments can be given in time.
Due to certain risk factors, complications during pregnancy may arise unexpectedly. In order to get healthy pregnancy, especially in high-risk pregnancy, a comprehensive pregnancy care provided by expert MFM specialists is highly essential. The sooner in pregnancy good care begins, the better for the health of both moms and their babies. If the abnormalities and complications are caught at its early stages, appropriate treatments to save both mothers and babies’ lives can be timely provided. More importantly, to promote a healthy pregnancy, mother-to-be should eat sufficient the five food groups, have light and appropriate exercise, take enough rest and avoid exposing to toxic substances e.g. X-ray, chemicals, smoke and certain medications those affect pregnancy as well as follow the doctor’s instructions strictly.
