Hearing you have a high risk pregnancy from your healthcare professional can bring about a lot of emotions. Your healthcare professional can answer any questions you might have and help you understand what it means to have a high risk pregnancy.
News of a high risk pregnancy may also come with a referral to a perinatologist. If you’ve never met with one before, you may be wondering who they are and what they do.
A perinatologist, also called a maternal-fetal medication (MFM) specialist, is an OB-GYN who specializes in high risk pregnancies. They focus on keeping parents and babies safe before, during, and after giving birth.
During a pregnancy, perinatologists can do more detailed testing and monitoring than an OB-GYN would normally offer. This may take the form of:
- specialized ultrasounds
- genetic testing for specific birth defects
- fetal blood testing
Based on their findings, perinatologists can suggest actions for a safer pregnancy and delivery. They frequently continue to monitor people throughout their high risk pregnancies.
In the postpartum period, a perinatologist may offer treatments for more complicated issues such as atypical blood pressure or heart conditions after the delivery.
What makes a pregnancy high risk?
Pregnancies may be considered high risk because of:
- existing health conditions
- birthing parent’s age
- health issues that happen before or during pregnancy.
Some examples of factors that can result in a high risk pregnancy are:
- preexisting cardiac or pulmonary problems
- high blood pressure
- being over 35 years old or under 20 years old
- carrying more than one baby
- a history of multiple miscarriages or pre-term births
It’s important to remember that every pregnancy is different, and high risk pregnancies aren’t always more dangerous or difficult than other pregnancies.
Perinatologists are highly trained doctors who specialize in keeping parents and babies safe throughout pregnancy and childbirth.
In addition to standard medical school training, a perinatologist will have completed a 4-year residency in Obstetrics and Gynecology and a 2-to-3-year fellowship program in Maternal-Fetal Medicine. In the United States, they will be board certified.
You might be referred to a perinatologist if you show signs of pregnancy complications or have a history of past pregnancy concerns.
Common reasons to be referred to a perinatologist can include:
- high blood pressure
- heart disease
- kidney problems
- having an in vitro fertilization (IVF) pregnancy
- being pregnant with multiples
- atypical screening results
- placenta abnormalities
- an injury during pregnancy
- using controlled substances during pregnancy
- premature labor
After being referred to a perinatologist, the first step is often an ultrasound. You can also expect a patient interview where information about your pregnancy, your health history, and some basic information about your baby may be gathered.
Depending on the reasons that brought you to a perinatologist, additional testing and diagnostic procedures may be performed to gain more information about the baby.
This may include:
- Fetal echocardiology. A fetal echocardiogram uses sound waves to produce images of the baby’s heart.
- Amniocentesis. During an amniocentesis, a small sample of amniotic fluid is drawn from your uterus through your abdomen. This fluid contains cells from both you and the baby and is examined to rule out genetic and chromosomal conditions.
- Chorionic villus sampling (CVS). During chorionic villus sampling (CVS), a small sample of placental cells, known as chorionic villi, are removed from your uterus. It may be similar to amniocentesis, with the sample being removed through your abdomen, or the cells may be removed by going through your vagina and cervix.
Once this information is gathered, the perinatologist may speak with you about a treatment plan for the rest of the pregnancy.
Unless they are meeting with you to create a pregnancy plan for your OB-GYN, you can expect to visit your perinatologist repeatedly. After the initial visit, they will continue to frequently monitor your pregnancy with additional screenings and check-ins.
Depending on their practice and the complications present, your perinatologist may even assist with the actual delivery of your baby or continue to see you during the immediate postpartum period.
Both an OB-GYN and perinatologist can deliver a baby. The biggest difference between an OB-GYN and a perinatologist is that a perinatologist has completed an additional 3-year fellowship or training in Maternal-Fetal Medicine.
During this time, a perinatologist has deeply studied:
- ultrasounds and diagnosis
- maternal critical care
- obstetrical surgery and anesthesia
- fetal evaluation and intervention
- treatment of rare or unique conditions
Need a little help finding a perinatologist?
Some perinatologists only accept referrals from other medical providers, so asking your current healthcare professional for a recommendation can be a good place to start.
Many insurance providers and healthcare networks have online databases where you can search for covered perinatologists, too.
If you find lots of perinatologists in your area, talking with other local people who have recently given birth and reading online reviews can help narrow down your search.
While you can always switch to a different perinatologist or OB-GYN at any time, it’s a good idea to establish a comfortable relationship with these healthcare professionals early in your pregnancy, if possible.
It’s not recommended to switch doctors too late in your pregnancy since it may lead to a lapse in treatment or a breakdown in communication between your different doctors. It’s important that you get the care you and your baby need at the appropriate times during your pregnancy.
Some questions for your perinatologist:
- What about my pregnancy makes it high risk?
- What types of testing do you recommend for me?
- Am I at risk for a pre-term delivery?
- Will you be the person to deliver my baby?
- What should I expect during delivery?
- What are the chances of needing a C-section?
- What foods should I eat or avoid?
- What types of exercise are appropriate?
- Are there any medications I should avoid or take?
- Do I need to increase or decrease my weight?
- Are there any vaccinations I should avoid or get?
- Can I continue working at my job? If so, for how long?
- What symptoms should I expect?
- When should I seek immediate help?
If your pregnancy is described as high risk, you may find yourself talking with a perinatologist. These highly trained specialists can help screen and diagnose potential complications. They can also help develop a care plan for you and your baby.
It’s important to remember that having a high risk pregnancy does not necessarily mean it will be a difficult one. It may just benefit from closer monitoring or further testing.
Whether your pregnancy is high risk or not, it’s important to notify your doctor if you have any concerns. They can help you get the resources, testing, or reassurance you need.
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