Every pregnancy deserves to receive special care and some require more than others. When a higher level of expertise for high-risk pregnancies is needed our specialists at UofL Physicians – Maternal-Fetal Medicine, part of UofL Physicians – OB/GYN & Women’s Health, offer compassionate care backed by academic expertise.
Whether a pregnancy is considered high-risk due to chronic hypertension, diabetes, a maternal heart condition, twins or more, or any number of other reasons, UofL Physicians’ highly-trained team collaborates to give mother and baby the best care possible. The team includes maternal-fetal specialists (doctors who specialize in the care and management of high-risk pregnancy), surgeons, cardiologists, endocrinologists, trauma specialists and even psychiatrists. We also partner with the nursing teams at UofL Health – UofL Hospital’s Center for Women & Infants for labor and delivery, and are prepared to care for you and your baby.
- Our maternal/fetal medicine group is a recognized referral center for high-risk pregnancies from Central and Western Kentucky in addition to Southern Indiana.
- We perform intrauterine transfusions and chorionic villus sampling.
- We offer expert state-of-the-art diagnostic ultrasound imaging, including 3D and 4D scanning when indicated, at our diagnostic and therapeutic ultrasound center.
Our team of committed professionals provides the best prenatal care to ensure a healthy start for your baby.
Diseases and conditions
Maternal-fetal medicine physicians detect and manage diseases and conditions that complicate pregnancy and delivery, such as:
- Problems with a previous pregnancy, such as multiple previous miscarriages, premature birth, low birth weight baby, Rh sensitization, prior cesarean delivery or a desire for Trial of Labor after Cesarean (TOLAC), prior stillbirth or early neonatal demise
- Cervical insufficiency, also known as incompetent cervix
- Intrauterine growth restriction (IUGR)
- Twins/multiples (multifetal gestation)
- Pre-pregnancy diabetes and gestational diabetes
- Chronic high blood pressure in addition to gestational hypertension, preeclampsia or eclampsia
- Sickle cell anemia or other blood disorders
- Maternal heart diseases such as repaired congenital heart malformation or coronary artery disease
- Kidney diseases such as chronic renal failure, nephropathy, kidney stones or lupus nephritis
- Placenta abnormalities such as placenta previa (covering the cervix) or placental abruption (premature separation of the placenta)
- Premature labor threatening to result in early delivery
- Hyperemesis gravidarum (excessive nausea and vomiting during pregnancy)
- Recurrent miscarriages (three or more consecutive miscarriages)
- Infections that could threaten a pregnancy, such as HIV/AIDS, STDs (sexually transmitted diseases), bacterial vaginosis (BV), cytomegalovirus (CMV), hepatitis B virus (HBV), hepatitis A virus (HAV), listeriosis, parvovirus BI9 infection (also known as Fifth’s disease), toxoplasmosis and urinary tract infections
- Complication from thyroid diseases (Graves disease, Hashimoto’s disease, hypothyroid)
- Complication from liver diseases (intrahepatic cholestasis of pregnancy, hepatitis, acute fatty liver of pregnancy
- Thrombophilias or clotting disorders, such as Factor V Leiden mutation, prothrombin gene mutation, antithrombin III deficiency, protein S and protein C deficiencies
- Autoimmune diseases, such as systemic lupus erythematosus
- Reproductive abnormalities, such as the double uterus
- Umbilical cord abnormalities, such as vasa previa, nuchal cord, umbilical cord cysts or knots
- Rh disease and other cases of alloimmunization
- Managing pre-existing conditions that require medications, such as seizure disorders, cancer, interstitial cystitis, Crohn’s disease or ulcerative colitis,
- Management of a wide range of obstetrical emergencies, such as maternal hemorrhage
- Women over age 35 or under age 16 who are pregnant
Treatments and services
Prenatal diagnostic testing
- Some fetal problems may be identified during pregnancy through tests our physicians perform. Depending on your needs, you and your physician will determine the best procedure to give the information needed.
- Prenatal diagnosis assists couples in making informed decisions regarding the management of their pregnancy.
- Genetic counseling assesses the risk of passing an inheritable disease or birth defect to your baby.
- Screening tests such as first-trimester screening and multiple marker screening (or quad test) provide information regarding the relative risk of having a baby with either a genetic (chromosomal) abnormality such as Down syndrome or a structural anomaly such as spina bifida.
- First-trimester screening for fetal chromosomal abnormalities is done between about 11 weeks and 13 weeks, six days of pregnancy. It combines two modalities, ultrasound and a maternal blood specimen. It provides information about a woman’s risk for having a child with Down syndrome (and extra #21 chromosome) and Edwards or Patau’s syndrome (and extra #18 or #13 chromosome, respectively).
- Multiple marker screening or quad test assesses the child’s risk for having a chromosomal abnormality or neural tube defect (spina bifida or anencephaly). It is a screening test, not diagnostic. Performed between the 16th and 20th weeks of pregnancy, a sample of the mother’s blood is drawn to help adjust a pregnant woman’s age-related risk.
- Diagnostic tests used to identify conditions are amniocentesis, chorionic villus sampling (CVS), targeted sonogram examination and percutaneous umbilical blood sampling (PUBS).
- Amniocentesis is a technique to obtaining amniotic fluid containing fetal cells from the “bag of waters” to analyze the cells for the number of chromosomes. It does require inserting a needle into the “bag of waters” to obtain the fluid containing the cells. It is usually done between 15 and 20 weeks of pregnancy for this purpose.
- CVS is a procedure to obtain a sample of the placenta to detect fetal chromosomal abnormalities. The test is used when information about the chromosomes of the fetus is desired earlier in pregnancy since it is done between 10 and 13 weeks of pregnancy. This test involves inserting a needle into the developing placenta to obtain the sample.
- High-resolution ultrasonography, including 3-D ultrasonography when indicated, helps identify fetal abnormalities.
- Percutaneous umbilical blood sampling (PUBS) detects chromosomal abnormalities and blood abnormalities (fetal hemolytic disease) and may be used to diagnose fetal infection (toxoplasmosis or rubella), abnormal fetal platelet count and Rh incompatibility (alloimmunization). It is rarely needed now but when necessary it typically is done later in pregnancy, at 20 weeks of pregnancy and beyond.
- Maternal blood tests can determine a woman’s status regarding the Rh factor, immunity to rubella (German measles), Parvovirus, toxoplasmosis and chickenpox.
- Cervical cerclage is a surgical procedure performed when the cervix cannot hold a pregnancy inside the womb against the forces of gravity. A stitch is placed to help the developing baby remain inside the uterus as long as possible or until 37-38 weeks of pregnancy. The procedure is often used if the mother has a history of second-trimester miscarriages without labor, a damaged cervix, a previous cone biopsy or LEEP procedure, or an inherited uterine anomaly.
- There are currently no treatments for fetal chromosomal abnormalities. When the condition is known before birth, full preparations can be made for the arrival of a child who will have special needs.
- Alloimmunized pregnancy, either from the Rh factor or other red blood cell factors, may require intrauterine transfusion of blood to the fetus to treat or prevent serious fetal low blood count. Our MFM specialists can provide this specialized service when necessary.
- When specialized delivery is required to provide the best care for the expected newborn, these arrangements are made in coordination with the medical services necessary, such as neonatology, anesthesia, pediatric anesthesia and specialized pediatric surgical services.