Maternal and Fetal Medicine: Services
Services offered by UF Health Maternal and Fetal Medicine at Jacksonville include:
Each pregnancy is special, and the physicians in the division treat and counsel
each mother with full attention to her specific needs. Below is a list of many of
the procedures and treatments available. In each situation, the mother receives
a thorough explanation so that she can make the decision she feels is best for her
and her baby and a comprehensive informed consent is obtained prior to the initiation
of any procedure.
Prenatal Diagnosis of Fetal Abnormalities
The division offers services in prenatal testing through a variety of techniques,
including blood tests to assess the risk of certain abnormalities and ultrasound
to look for fetal structural abnormalities. In addition, non-stress testing is conducted
in patients at risk for a miscarriage. These tests give assurance to the patient
and the physician that the fetus is healthy, thereby allowing the pregnancy to reach
Are the tests dangerous to either my baby or me?
The usual tests for prenatal diagnosis are not invasive and not dangerous to either
the mother or the fetus.
How accurate are the tests in showing that my baby is normal?
Test results are not 100 percent accurate, but are very close. When the full panel
of tests has been completed and no abnormalities are detected, there is good reason
to believe the pregnancy will result in a healthy baby.
How many times do I need to be seen by the doctor during my pregnancy?
Frequency of visits depends on the results of the testing. In many cases, obtaining
all of the necessary information may require several visits. In the case of non-stress
testing and contraction stress testing with biophysical profiles, tests are performed
on a weekly basis until delivery.
Preeclampsia, Eclampsia and Hypertensive Disorders
Unfortunately, high blood pressure does occur in pregnancy and the physician must
determine whether this is a problem related to the pregnancy, such as preeclampsia
or eclampsia, or if it is chronic hypertension that has been made worse by pregnancy.
The diagnosis depends on checking the blood pressure throughout the pregnancy, as
well as examining the urine for excessive protein. The treatment of elevated blood
pressure during pregnancy depends on factors such as the severity of blood pressure
and how the fetus is tolerating the elevated blood pressure. Frequently, medications
are needed to control blood pressure and prevent maternal problems.
How does an increase in blood pressure affect my baby?
An increase in the mother's blood pressure can adversely affect the baby by decreasing
the blood flow to the baby. Most of the time, this does not cause harm to the baby
if the blood pressure is adequately controlled. However, close monitoring is necessary
because if the blood pressure is not controlled, the baby may suffer permanent damage.
Does it mean I will have this problem with the next pregnancy?
Blood pressure problems are far more common during the first pregnancy. Preeclampsia
is unusual after the first pregnancy. However, patients who have a problem of elevated
blood pressure that is inherited and not related to the pregnancy may have an increase
in their blood pressure with subsequent pregnancies.
Recurrent Pregnancy Loss
Pregnancy loss is defined as the result of an inability to carry a pregnancy to
full term (40 weeks). Miscarriages may occur during the first three months of pregnancy
because of some fetal abnormalities. In other situations, they may occur as the
result of a cervix that does not allow the pregnancy to stay in the uterus during
the second three months of pregnancy.
Fifteen to 20 percent of all pregnancies result in an early pregnancy loss. Most
of the time, this is not a problem that occurs in subsequent pregnancies. Recurrent
pregnancy loss is only considered to be a medical problem that needs evaluation
after three consecutive miscarriages. There are many causes of recurrent pregnancy
loss. Testing is aimed at identifying a cause that can be corrected, including infection,
insufficient cervix or abnormal uterus. Evaluations include cultures, measuring
cervical length, pelvic ultrasound and, occasionally, chromosomal analysis.
What are the chances that I will lose my next pregnancy?
It depends on whether the previous losses were due to a condition that might still
be present (an abnormal uterus, for example). If so, appropriate treatments may
decrease the chance of another loss.
It is known that pregnancies grow at a certain rate. Although there are some differences
in the sizes of babies throughout pregnancy, a concern can develop when the stage
of pregnancy and the expected size do not correspond.
Evaluation includes performing an ultrasound to look for abnormalities of the baby
and for the amount of amniotic fluid present. A finding of a fetus being small for
the gestational stage of pregnancy may mean that the placenta is not functioning
adequately. In this situation, close follow up of the pregnancy is necessary, including
non-stress testing, contraction stress testing and biophysical profiles.
What would cause my baby to be larger than expected?
Several conditions make a baby seem larger than expected, including diabetes, excess
amniotic fluid and more unusual conditions, such as blood incompatibility problems.
There are cases in which some babies are just larger than normal.
What would cause my baby to be smaller than expected?
Occasionally, there is an inadequate amount of amniotic fluid that may be a symptom
of a fetus's poor kidney function. Another cause is inadequate blood supply to the
placenta, which may be related to hypertension during pregnancy.
Bleeding during pregnancy is abnormal. Near the end of pregnancy, there are two
specific conditions that may complicate a pregnancy. One such condition is placenta
previa, a low placed placenta that bleeds as the cervix starts to dilate before
the onset of labor. The other is a premature separation of the placenta. Both of
these conditions demand prompt evaluation, primarily with sonography.
Is it possible to have a normal delivery with these conditions?
It depends on the condition of the woman and fetus at the time of diagnosis. Cesarean
section is very common with both of these diagnoses, and in cases of complete placenta
previa, a cesarean section is almost always necessary. Occasionally, when the placental
abruption occurs with the cervix completely dilated, a vaginal delivery is possible.
An amniocentesis is an insertion of a needle through the abdominal wall into the
uterus to withdraw amniotic fluid. Cells in the fluid are tested to determine if
the baby is chromosomally normal.
Will the procedure hurt my baby or me?
The procedure is almost painless and has little risk for the baby. It is performed
with ultrasound guidance to avoid hitting the placenta or the baby with the needle.
There is a very small risk of interrupting a pregnancy or causing an early labor,
but this occurs in less than 1 percent of patients.
When is amniocentesis done?
It depends on the purpose of the amniocentesis. If the test is ordered to confirm
that the baby is developing normally, it is usually done at around three to four-and-a-half
months of pregnancy. If it is ordered to determine that the baby's lungs are mature
when an early delivery is medically needed, it is performed prior to delivery.
Minimally Invasive Fetal Surgery
Several procedures are performed by the maternal fetal medicine specialists using
minimally invasive surgery: vesicoamniotic shunts, thoracic shunts and cord blood
sampling. These procedures are ordered for patients who have been shown to have
structural anatomic abnormalities that would be potentially harmful for the baby
if intervention were not carried out prior to delivery.
Will my baby be injured by this type of surgery?
In general, this surgery is reserved for cases in which a known abnormality exists
and without treatment, a negative outcome would be expected. While there are risks
involved with surgery, the benefit outweighs them.