Perinatology is a subspecialty of obstetrics and gynecology. A perinatologist assists obstetricians and other healthcare providers in delivering individualized, special care for the fetus and for complicated, high-risk pregnancies.

Commonwealth Perinatal Services (PDF)

Pre-Conception counseling

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.

Prenatal Diagnosis

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

Fetal Surveillance

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.

Complications Management

Women carrying more than one fetus or those who experience preterm labor need careful medical monitoring. Women with cervical incompetence (when the cervix begins to dilate and thin too early in the pregnancy) benefit from advanced surgical procedures. We offer antepartum care for mothers-to-be who need early hospitalization prior to giving birth.

Gynecologic Services

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.

Staff

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.

Insurance

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.