Maternal Fetal Medicine

St. Luke’s Maternal Fetal Medicine offers a wide range of services for average and high-risk pregnancies. Our team includes physicians, nurse practitioner, nurses, and sonographers with expertise in fetal ultrasound, as well as in the management of high-risk maternal and fetal conditions. We work in cooperation with each patient’s obstetrician to optimize the outcome of each pregnancy.

Services offered include:

Pre-conceptual counseling

Pre-conception consultations are suggested for patients who have medical conditions that may make a pregnancy more high risk, or have had complicated pregnancies in the past. During these consultations, we review the medical and pregnancy history in depth, and provide guidance on what to expect during a future pregnancy. Optimizing chronic conditions prior to pregnancy improves pregnancy outcomes, and when needed we work with any specialists to help a mother to enter her pregnancy in as optimal health as possible.

Prenatal Ultrasound

St Luke's Maternal-Fetal Medicine is pleased to offer high quality obstetric ultrasound in all trimesters of pregnancy, including nuchal translucency measurement (11-14 weeks), detailed fetal anatomic survey (18-22 weeks gestation), transvaginal cervical length screening (16-23 weeks gestation), fetal echocardiography, as well as third trimester fetal ultrasound (when indicated) and antepartum fetal surveillance (non-stress testing, amniotic fluid assessment, biophysical profile). Our commitment to providing exceptional obstetric ultrasound is evidenced by our accreditation by the American Institute for Ultrasound in Medicine (AIUM). Achieving AIUM accreditation includes a voluntary, rigorous peer-review process that allows practices to demonstrate that they meet or exceed nationally-recognized standards in the performance and interpretation of diagnostic ultrasound examinations.

Ultrasound is the most widely used medical imaging method for viewing the fetus during pregnancy. Ultrasound may be done either on the mother’s abdomen (transabdominal) or in the vagina (transvaginal). Ultrasound utilizes sound waves to produce images. During an ultrasound exam, a transducer sends sound waves through the body. The sound waves meet tissues, body fluids, and bones, and bounce back, like echoes. The transducer receives these echoes, which are turned into images. The ability to obtain ideal images depends on several factors, including the position of the fetus, and the distance the sound has to travel (through the abdominal wall, for example). The images can be viewed in real time by the patient and her support person during the visit on a video screen. All ultrasound examinations will be performed by registered diagnostic medical sonographer and interpreted by a Maternal-Fetal Medicine Physician.

• First trimester

  (Limited) anatomy with nuchal translucency measurement

  Ultrasound at 11-14 weeks gestation can evaluate early fetal development, and helps provide early information about your pregnancy’s risk for birth defects and genetic syndromes. If desired, additional genetic screening or definitive testing can be ordered in conjunction with this ultrasound.

• Second trimester

  Detailed anatomic survey and cervical length screening (trans vaginal ultrasound)

  The 18-22 week ultrasound is often called the “anatomy scan.” This ultrasound involves thorough imaging and measurements of the fetus, including face, brain, spine, heart, kidneys, diaphragm, chest, stomach, bladder, genitals, limbs, feet, hands, and the umbilical cord. The placenta and amniotic fluid are routinely evaluated as well. This study includes a vaginal ultrasound to measure the cervix, which is a helpful tool in estimating whether the pregnancy is at increased risk for preterm delivery.

Fetal echocardiography

This is a detailed ultrasound focused on evaluation of the fetal heart. This is done only in select pregnancies with increased risk for congenital heart disease. Common reasons to need a fetal echocardiogram include prior child with congenital heart disease, diabetes (pre-gestational, or diagnosed in the first or second trimesters), abnormal genetic testing results, or pregnancies conceived through in vitro fertilization. Fetal echocardiograms are interpreted by the Maternal-Fetal Medicine Physicians, or if needed, by a pediatric cardiologist if needed.

Fetal growth assessment

Follow-up evaluation of fetal growth and amniotic fluid are on an as-needed basis following the fetal anatomic survey, and need for these ultrasounds depends on individual medical history. If the anatomic survey is complete, and there are no pregnancy complications, follow-up ultrasounds may not be indicated after the fetal anatomic survey)

Antepartum fetal surveillance

Antepartum fetal surveillance (Antepartum surveillance is done to monitor pregnancies that are at higher risk for complications, and provides information about fetal well-being while a mother is awaiting delivery. Individual frequency and timing of testing are determined by the perinatologist based on the mother’s medical and pregnancy history)

• Non-stress testing (not an ultrasound, but often done in conjunction with ultrasound)
• Biophysical profile
• Amniotic fluid assessment

Genetic Screening and/or Diagnostic Testing

first trimester MFM brochure here

• Sequential screening
• Non-Invasive Prenatal Testing (NIPT)/Cell-Free DNA (CFDNA)
• Chorionic Villus Sampling
• Amniocentesis

This video highlights the different screening options available to assess genetic risks during pregnancy.

Genetic Counseling

We have two prenatal genetic counselors, who are able to provide you a comprehensive review of your prenatal genetic screening and testing options. They also take an in-depth family history to review any unique genetic risks related to your family and ethnic background. Carrier screening for recessive conditions (such as Spinal Muscular Atrophy, Cystic fibrosis, Hemoglobin Electrophoresis, and expanded carrier screening) are also offered during genetic counseling sessions.

You might also be referred for a genetic counseling session in the event of an unexpected ultrasound finding (such as a soft marker, or a birth defect). In this case, the genetic counseling session would focus on what genetic syndromes these findings could be associated with, and whether a couple would like to elect definitive prenatal testing using (chorionic villus sampling) CVS or Amniocentesis.

Comprehensive diabetes management (Gestational or Pre-Existing)

The St. Luke’s Maternal Fetal Medicine Diabetes and Pregnancy Program uses a team approach to optimize the pregnancy outcomes of mothers with Diabetes. Our accredited team is led by Alma Cruz CRNP, a certified registered family nurse practitioner who is board certified in advanced diabetes management. Our team is additionally comprised of an OBGYN registered nurse, 3 registered dietitians (who are also certified diabetes educators), and one medical assistant. We manage all types of diabetes (including Type 1 diabetes; Type 2 diabetes and gestational diabetes) and work closely with each patient to help them achieve a healthy pregnancy outcome. We utilize the latest diabetes technology and provide individualized care that is unique to each patient. We enjoy the challenge of working with mothers to manage their diabetes and pregnancy to achieve healthy pregnancy outcomes.

Additional services include Nutrition Counseling and Fetal blood sampling/percutaneous umbilical blood sampling, fetal transfusion.