High-risk mothers and babies throughout the Louisiana Gulf South region come to Woman’s for our medical expertise. We offer diagnostic tests and specialty services to help guide a healthy pregnancy and delivery.
Advanced Maternal Age
As a woman increases in age, her risk of having a baby with a genetic abnormality also increases. Classically advanced maternal age is defined as a mother over the age of 35 at the time of the expected date of birth. Your obstetrician will discuss with you elective options (called screening tests) to better assess your chances of having a baby with a genetic abnormality. Additionally your doctor may send you to meet with our Maternal Fetal Medicine doctors to review your results and to assess the fetus with a detailed ultrasound of the baby.
Abnormal screening tests
As part of routine pregnancy care, your obstetrician will offer you testing to assess your baby’s risk of having abnormalities such as Down syndrome or spina bifida. If these tests results note an increased risk of abnormality then your physician will send you to meet with our Maternal Fetal Medicine team to undergo a detailed ultrasound assessment of your baby and to review the results in depth. Rest assured, most times these screening tests are alerting your doctor to take a closer look, but very rarely mean your baby has a problem.
Diabetes in pregnancy
Diabetes is condition of abnormal sugar control that can present for the first time in pregnancy. Additionally, if present before pregnancy, diabetes can worsen with advancing gestation. During pregnancy some mothers will experience high levels of sugar (glucose) in their blood (known as hyperglycemia). If not treated, persistent hyperglycemia can lead to poor neonatal outcomes. Our team of physicians, nurses and dietitians will work with your doctor to outline a plan to decrease your risk for your baby.
Hypertension in pregnancy
Hypertension, also known as high blood pressure, can be present prior to pregnancy and, in some cases, can present for the first time during pregnancy. Uncontrolled high blood pressure can be bad for mother and baby alike. If you have a history of high blood pressure, or if you develop it during pregnancy, your doctor may send you to our Maternal Fetal Medicine team to outline a plan to achieve the best outcome for you and your baby.
Prior preterm birth
Women who have a history of a prior spontaneous preterm delivery, defined as a delivery prior to 37 weeks of pregnancy, have an increased risk of having another baby deliver preterm with their future pregnancies. Your doctor may send you to meet with our team to review our prior pregnancy. Then our Maternal Fetal Medicine team in conjunction with your doctor will outline a regimen of therapy to decrease your risk of recurrent preterm birth using intervention such as progesterone injections, cervical length surveillance, and cervical cerclage.
Ultrasound is a safe, effective, noninvasive diagnostic test that uses sound waves to show our specialists pictures of your unborn child. Ultrasound also gives our specialists a detailed view of conditions in your uterus. Your obstetrician may request our team to perform a detailed ultrasound if you have a prior child with an abnormality or if they have seen something abnormal on their own testing.
Our specialty team sometimes uses 3-D and 4-D ultrasonography for more detailed views of your unborn child to diagnose congenital abnormalities. This type of ultrasound is particularly good for evaluating fetal abnormalities such as cleft lip and palate or spinal defects.
A fetal echocardiogram is a special, targeted form of ultrasound used to view the heart of a fetus in real time. Physicians use these images to evaluate an unborn child’s heart for congenital heart defects. This type of ultrasound is usually reserved for babies at risk of defects or when a defect is seen on routine ultrasound and better definition is needed.
A fetal MRI (magnetic resonance imaging) is a special test that is performed in the radiology department that enables the physicians to get a more detailed look at your baby or other structures in the mother’s abdomen. The test is usually done in cases of fetal brain abnormalities, congenital diaphragmatic hernia or if there is an issue with placental attachment. The procedure uses very powerful magnets to outline soft tissues and is considered preferable to CT scan in pregnancy as it does not expose the fetus to radiation.
Cystic Fibrosis Carrier Testing
There are two types of tests that can tell you if you have CF or if you’re a carrier. Both are safe to take during pregnancy. Your partner can have the tests, too.
• A blood test
• A swab of cells inside your mouth. This means your provider rubs a cotton swab against the inside of your cheek to get some cells.
If you or your partner has CF or is a CF carrier, you can have a prenatal test to find out if your baby has the condition or is a carrier. You can have either of these tests:
• Chorionic villus sampling (also called CVS). This test checks tissue from the placenta for birth defects and genetic conditions. You can get CVS at 10 to 12 weeks of pregnancy.
• Amniocentesis (also called amnio). This test checks amniotic fluid from the amniotic sac around your baby for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy.
A simple blood test can identify Tay-Sachs carriers. Blood samples can be analyzed by either enzyme assay or DNA studies. The enzyme assay is a biochemical test that measures the level of Hex-A in a person's blood. Carriers have less Hex-A in their body fluid and cells than non-carriers.
Sickle cell anemia
There are two main ways of checking your baby for genetic problems while it is in the womb. These techniques are called amniocentesis and chorionic villus sampling (CVS).
• Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. This is an outpatient procedure. The test involves placing a needle in to the womb through the woman’s abdomen and obtaining a small sample of the fluid in which the baby floats (the amniotic fluid). Most women say that the test is not painful.
• Chorionic Villus Sampling (CVS) test is carried out earlier then amniocentesis – at around the 9th or 10th week of pregnancy, and again it is an outpatient procedure. This test takes a very small amount of material from the developing placenta. Typically this test is performed by placing a thin tube through the cervix (neck of the womb) to obtain the sample. Most women say that it is only slightly uncomfortable.
Amniocentesis is a procedure in which amniotic fluid is removed from the uterus for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. This fluid contains fetal cells and various chemicals produced by the baby. Although amniocentesis can provide valuable information about your baby's health, it's important to understand the risks of amniocentesis — and be prepared for the results.
Amniocentesis can be done for various reasons:
- Genetic testing. Genetic amniocentesis involves taking a sample of amniotic fluid and testing it for certain conditions, such as Down syndrome.
- Fetal lung testing. Fetal lung maturity testing involves taking a sample of amniotic fluid and testing it to determine whether the baby's lungs are mature enough for birth.
- Diagnosis of fetal infection or anemia. Occasionally, amniocentesis is used to evaluate a baby for infection or other illness. The procedure also can be done to evaluate the severity of anemia (low blood cell count) in babies who have Rh sensitization — an uncommon condition in which a mother's immune system produces antibodies against a specific protein on the surface of the baby's blood cells.
- Amnioreduction. If you accumulate too much amniotic fluid during pregnancy (polyhydramnios), you may be at risk for an early delivery or may have severe discomfort from the large amount of fluid. An amniocentesis might be done to drain excess amniotic fluid from your uterus (amnioreduction) to decrease risk of labor or to provide maternal comfort.
The procedure involves cleaning the mother’s abdomen then placing a needle in to the womb under ultrasound guidance to obtain a sample of the fluid in which the baby floats (the amniotic fluid). Most women say that the test is not painful.
Most times an amniocentesis is completed at 16-20 weeks of pregnancy for genetic testing however it can be done anytime in pregnancy after 15 weeks depending on the condition that is seen or needs treatment.
Genetic amniocentesis can provide information about your baby's genetic makeup. Generally, genetic amniocentesis is offered when the test results might have a significant impact on the management of the pregnancy or your desire to continue the pregnancy.
Genetic amniocentesis is usually done between week 15 and 20 of pregnancy. Amniocentesis done before week 15 of pregnancy has been associated with a higher rate of complications.
You might consider genetic amniocentesis if:
- You had positive results from a prenatal screening test.
- You had a chromosomal condition or a neural tube defect in a previous pregnancy.
- You're 35 or older.
- You have a family history of a specific genetic condition, or you or your partner is a known carrier of a genetic condition.
- You have abnormal ultrasound findings.
A fetal non-stress test is a simple, painless test that listens to your baby’s heart rate to assess his or hers’ health. It works by placing a small microphone on the mother’s abdomen and listens to hear increases and decreases in the fetal heart rate. It is designed to assess the amount of oxygen the baby is receiving to ensure fetal well being. A baby with good oxygen levels will have a many increases and decreases (called variability) in the heart rate over a short time period (approximately 20 min). If you have high blood pressure or diabetes your doctor may recommend to utilize this test near the end of pregnancy to keep a close assessment of your baby. Sometimes this test is used in addition to a fetal biophysical profile.
A biophysical profile is also a simple, painless test using ultrasound that's performed during pregnancy to assess your baby's well-being – specifically, whether he's getting enough oxygen in the womb. It's typically done if you've gone past your due date. It can also be used sometime in your third trimester if you're having a high-risk pregnancy.
What to expect
The test starts with an ultrasound to observe your baby's body movements, muscle tone (flexing the arms and legs), and breathing movements (the baby's ability to move her chest muscles and diaphragm), and the amount of amniotic fluid surrounding her.
Depending on the results of the ultrasound, your caregiver may follow it with a nonstress test to assess whether your baby's heart rate changes when she's moving. For this, you lie on your left side and a technician straps two devices to your belly: One monitors your baby's heartbeat and movement, and the other records contractions in your uterus. The technician listens to and watches your baby's heart beating on an electronic screen.