Perinatology is a subspecialty of obstetrics and gynecology. The perinatologist assists obstetricians and other health care providers in delivering individualized, risk-appropriate care for pregnant women at risk for adverse maternal, fetal or neonatal outcomes.
The perinatologist evaluates and provides advice to women who want to have a baby but who worry they may be at risk for complications. This includes women who have an underlying medical illness such as diabetes or hypertension or those who must consider the possibility of genetic complications. The perinatologist provides all pertinent information needed to assist couples in making informed decisions, and then provides guidance and support for the chosen course of action.
Many new techniques allow doctors to identify and monitor potential problems with the pregnancy. These procedures include:
First Trimester Sonographic Evaluation
- Identification of pregnancy location and number
- Assessment of viability
- Gestation age
- Screening for Down's Syndrome
Second Trimester Sonographic Evaluation
- Screening for Down's Syndrome and other genetic abnormalities
- Screening for structural birth defects, including spina bifida, heart defects, cleft lip and palate, and skeletal abnormalities
Invasive Prenatal Diagnostic Testing
- Amniocentesis (removal of small samples of amniotic fluid for genetic testing or for assessment of other conditions)
- Fetal blood sampling
- Chorion villus sampling
In the late second and early third trimester, many pregnancies are at risk for adverse outcomes and have been shown to benefit from close fetal surveillance.
- Serial sonography for evaluation of growth
- Umbilical artery doppler blood flow analysis in the growth restricted fetus
- Middle cerebral artery blood flow analysis in the fetus at risk for anemia (i.e.,blood group incompatibility, parvovirus infection)
- Non-stress and biophysical profile testing in any fetus at risk for stillbirth
Monitoring of Pregnancies at risk for Preterm Delivery
Women with prior preterm birth, multiple gestation, prior cervical or uterine surgery or other risk factors for early preterm delivery may benefit from transvaginal sonographic evaluation of cervical anatomy. Patients with early cervical change may be offered transvaginal or transabdominal cerclage procedures in an attempt to prolong gestation. Patients with a wide variety of medical conditions (diabetes, chronic hypertension, systemic lupus erythematofis, etc.) may benefit from frequent evaluation.
Women carrying more than one fetus or those who experience preterm labor need careful medical monitoring. Those with cervical incompetence benefit from advanced surgical procedures.
Although perinatology deals primarily with issues of pregnancy, the field has some applications for other women as well. From pelvic ultrasound to saline infusion sonography, a number of different procedures allow the perinatologist to help women with pain and abnormal bleeding. Specific tests allow physicians to visualize intrauterine structures, assess the endometrium, and identify fibroids and polyps.
In addition to maternal-fetal medicine specialists, staff members include a nurse educator and ultrasound technologists certified by the American Registry of Diagnostic Medical Sonographers.
The obstetrical field has well-established guidelines that govern insurance payments. Perinatal care is usually covered since it prevents costly complications at a later date.