South Shore Hospital's Maternal-Fetal Medicine Program assists women whose pregnancy may be affected by their age, a chronic health condition, the likelihood of multiple births, or other medical issues. Call 781-340-8430.
Providing High-Risk Pregnancy Care
Although most pregnancies call for routine prenatal care from conception through delivery, some expectant mothers face pregnancy-related risks or complications that require a special level of attention.
The Maternal Fetal Medicine Program at South Shore Hospital is designed specifically for women with high risk pregnancies. Our comprehensive services include the latest in maternal and fetal screening, diagnostic testing, level II ultrasound, and consultative services.
Expert Attention for Exceptional Needs
There are many reasons why a pregnant woman may be referred to our Maternal Fetal Medicine Program for prenatal and obstetric care. Common risk factors include the following:
- Maternal age
- Personal medical and/or family history
- Complicated obstetric history
- Multiple gestation: (twins, triplets, or more)
- Conditions that arise in
pregnancy, such as gestational diabetes
or hypertension - Issues with fetal growth or development
- Desire for screening or diagnostic testing
Teaming with Specialists
At South Shore Hospital, our Maternal-Fetal Medicine Program offers expert and compassionate care to mothers and their babies. Our team is comprised of highly skilled providers who collaborate to ensure quality care in a supportive atmosphere.
Maternal-Fetal Medicine Physicians
Maternal-fetal medicine
physicians are obstetrician/gynecologists who complete
an additional three year Fellowship in high risk obstetrics and are board
certified
in both disciplines.
Maternal-Fetal Medicine Nurse Coordinator
Our maternal-fetal medicine nurse provides education about pregnancy, screening, and the birth process. She also coordinates the care plans designed or recommended by our physicians, organizing care with patients and other providers both within and outside of South Shore Hospital.
Obstetric Sonographers
Our obstetric sonographers are specifically trained to perform targeted Level II ultrasound examinations, specialized measurements, and to provide ultrasound guidance for our physicians when invasive testing is indicated. Our sonographers are certified as Registered Diagnostic Medical Sonographers.
Genetic Counselors
Our genetic counselors assist patients and families with genetic and non-genetic concerns, serving as a resource to patients, families, and health care providers regarding counseling and informed decision-making. They work closely with patients during highly stressful times and deal with sensitive information in an empathetic and supportive manner.
The Most Comprehensive Care in the Region
Reproductive Endocrinology Program
Our Weymouth-based reproductive endocrinology program provides specialized care for women with fertility complications. We provide access to the most current reproductive services available, including diagnostic and treatment options. Our program is offered in association with Brigham and Women's Hospital.
Multidisciplinary Team Approach
Our Perinatal Care Team (PCT) represents experts from various disciplines who work with patients and families to create a care plan that addresses their unique medical, psychosocial, and spiritual needs when faced with serious healthcare challenges and decisions during pregnancy. The PCT ensures that all communication between patient, family, and staff remains clear and seamless and that patients are supported throughout an unexpected journey.
Regional Neonatology Program
Our Neonatal Intensive Care Unit (NICU) provides advanced neonatal intensive care for ill or premature infants. Our NICU is staffed 24 hours a day, seven days a week by board-certified neonatologists who are on staff at both South Shore Hospital and Children’s Hospital. Please visit our NICU website for additional information.
Specialized Fetal Care
Through our association with the Advanced Fetal Care Center at Children’s Hospital, we have direct access to a multidisciplinary team of pediatric specialists who provide consultation and coordinated care, including fetal MRI, cardiac evaluation, and fetal surgery for complex fetal abnormalities.
Advanced Services and Procedures
Prenatal Screening and Diagnostic Tests
The Maternal Fetal Medicine Program at South Shore Hospital provides a full range of sophisticated prenatal screening and diagnostic options. Risk and benefit discussions regarding each type of testing are provided by our staff.
Every woman, no matter her age, has a risk of having a baby with a birth defect. Most problems do not run in families and are not inherited. The majority of women of all ages will have healthy babies. As women age, however, there is increasing risk of having a baby with a chromosome abnormality (e.g. Down syndrome).
The purpose of prenatal screening is to identify the probability that a specific condition is present during pregnancy. Although screening tests do not provide a definitive answer, they can determine if a woman has an increased or decreased risk of a particular problem. Screening is not invasive and does not pose a risk to the pregnancy.
Diagnostic tests differ from screening tests. A diagnostic test usually determines with great accuracy whether or not a specific problem exists, but may pose a small risk to the pregnancy.
What to Expect
Pre-Registration
Pre-registration must be
completed prior to each appointment in the Maternal Fetal
Medicine unit. Please call 781-340-4090, option #1, prior to the visit.
Waiting Time
The duration of the ultrasound examination may range from 15 minutes to one hour or more. Twins and triplets will require longer visits. At times, unexpected complications may arise with a patient, which in turn may result in the delay of a scheduled appointment.
Visitors and Children
We understand that a prenatal ultrasound can be a very exciting experience for a woman and her family. Because this is a medical examination, it may not always be appropriate to have children present. If a child is present (under the age of 10), he/she must be supervised by an accompanying adult other than the patient. Two adults in addition to the patient are allowed in the examination room at one time.
Photos and Videos
Patients are given pictures from their ultrasound examination. Videotaping of the ultrasound examination is not permitted.
First Screenİ
First Screenİ involves an ultrasound examination and a blood test. The ultrasound is used to measure an area in the back of the fetal neck called the nuchal translucency (NT). A blood test is then performed to analyze specific chemicals produced during early pregnancy. The measurement of the NT and the chemicals in the blood are then combined in a formula to provide two risk estimates; a risk for Down syndrome (trisomy 21) and a risk for trisomy 18. This is a screening test, not a diagnostic test, which means it provides only an estimate of risk. First Screenİ does not provide information for neural tube defects (spina bifida).
First Screenİ can detect
approximately 83 – 85% of babies with Down syndrome and 80%
of babies with trisomy 18.
Integrated Screening
Integrated screening, a combination of First Screenİ and quad screening, is a two-part process beginning between 10 - 13 weeks of pregnancy and concluding after the 16th week of pregnancy. The screening requires two visits. By combining the information obtained through both visits, risks are provided for Down syndrome, spina bifida, and trisomy 18.
Integrated screening can detect approximately 92% of babies with Down syndrome, 90% of babies with trisomy 18, and 80% of those with open nueral tube defects.
If the NT cannot be obtained due to fetal position, the woman is given the option of serum(2 blood tests without NT) integrated screening, which has an 87% detection for Down syndrome.
Sequential Screening
Sequential screening follows the same testing pattern as integrated screening, but allows for preliminary results to be available following the initial visit, with final results available after the 16th week of pregnancy.
Sequential screening can detect approximately 90.4% of babies with Down syndrome, 90% of babies with trisomy 18, and 80% of those with open neural tube defects.
Down syndrome (trisomy 21)
Down syndrome is a chromosome abnormality resulting from the presence of an extra chromosome 21. It is a common genetic cause of mental retardation and may be associated with other health problems.
Open neural tube defects (spina bifida)
Spina bifida is a condition where a portion of a baby’s spine does not close properly. The condition may result in paralysis, lack of bowel and bladder control, curvature of the spine, and abnormalities of the brain.
Trisomy 18
Trisomy 18 is a chromosome abnormality due to the presence of an extra chromosome 18. It results in significant mental retardation and multiple birth defects. Most babies will not survive with this condition.
Patients who are identified at a higher risk are “screen positive.” Results are discussed with each woman who receives a positive screen. Some patients will then opt for a diagnostic test (chorionic villus sampling or amniocentesis). If results are “screen negative,” indicating a decreased risk, results will be shared by either the maternal fetal medicine staff or your obstetrical provider.
Level II Ultrasound
A level II ultrasound examination, also referred to as a “targeted ultrasound,” examines the structure (anatomy) of a baby and can also evaluate the placenta and umbilical cord, as well as determine the level of amniotic fluid. The non-invasive examination is most often performed around 18 - 20 weeks of pregnancy and can detect many types of birth defects, although not all problems can be seen or identified. Women who are not considered “high-risk” may have a level II ultrasound examination performed for reasons such as family history or previous pregnancy with a maternal or fetal complication.
Biophysical Profile (BPP)
A biophysical profile is a test of fetal well-being that involves evaluating an unborn baby’s movements, tone, practice breathing movements, and amniotic fluid level by ultrasound. Each element of the test is scored as 2, meaning present, or 0, meaning absent. The BPP is a tool used during the third trimester and may be combined with a non-stress test which evaluates the baby’s heart rate pattern. BPP scores that are not reassuring indicate a need for closer observation or delivery.
Amniocentesis
Amniocentesis is a diagnostic test offered after 15 weeks of pregnancy during which a thin needle is placed into the pregnant woman’s uterus to withdraw a small sample of the amniotic fluid from around the baby. Fetal skin cells floating in the amniotic fluid are tested for chromosomal abnormalities and other genetic conditions. Analyzing other contents of the amniotic fluid by the same method late in pregnancy can help determine whether a pre-term baby's lungs are likely to be mature and functioning if birth is earlier than expected.
Chorionic Villus Sampling (CVS)
Chorionic villus sampling, a diagnostic test available only between 10 and 12 weeks of pregnancy, involves placing a needle into the pregnant woman’s uterus to sample a small amount of placental tissue. This tissue can be tested for chromosomal abnormalities and other genetic conditions. While CVS offers genetic information earlier than amniocentesis, this test does not provide information on neural tube defects such as spina bifida.