Women are often referred by their care provider for consultation with a Maternal-Fetal Medicine specialist when she has a history of or a current condition that may pose risk to a pregnancy. The specialist will evaluate the woman’s history and current pregnancy, identify potential risks, and provide recommendations for the best care to the woman and her referring provider.

Maternal-Fetal Medicine specialists may work with the referring provider to co-manage a woman’s medical condition. Co-management of complex conditions is sometimes necessary to ensure optimal care is given.

Some conditions that may require consultation and/ or co-management may include:

• Multiple Gestation (twins, triplets)
• Fetal anatomic abnormalities (heart, brain, limbs, etc.)
• Growth abnormalities (fetal growth restriction, large for gestational age)
• Placental or Umbilical Cord abnormalities
• Genetic disorders

• Advanced Maternal Age (>35 years old at time of delivery)
• Hypertension
• Diabetes
• Thyroid Disease
• Congenital heart disease
• Autoimmune disorders (i.e. Lupus)
• Obesity
• Substance use or medication exposure
• Infertility
• Clotting Disorders
• Uterine abnormalities

• Gestational hypertension, Preeclampsia, HELLP Syndrome
• History of cervical insufficiency or cervical dilation in early pregnancy
• Preterm labor and delivery
• Prior child with genetic syndrome or anatomic abnormality
• History of stillbirth

For some pregnancy conditions it is recommended that the fetal wellbeing be monitored closely in the third trimester. These tests may include an ultrasound called a Biophysical Profile or BPP by which our sonographer looks for fetal movement, fetal muscle tone, practice fetal breathing movements, and the amniotic fluid level to evaluate current fetal health. Another test is the Non-Stress Test or NST which involves evaluating the pattern of the fetal heart rate and the presence or absence of uterine contractions with a monitoring device. The pattern of a fetal heart gives the provider information about current fetal health. In many cases testing will be recommended twice a week starting at 28-32 weeks gestation until delivery.

Maternal-Fetal Medicine offers pre-conceptional counseling to women who need guidance about future pregnancy. The goal of counseling is to reduce the risk of adverse outcomes by helping a woman optimize her health, address modifiable risk factors, and provide education. The most common reasons to see an MFM for pre-conceptional counseling is due to one or both parents having a genetic disorder, history of a previous child or close family member with a genetic disorder, or multiple pregnancy losses.

Genetic counseling may also be offered to women with a diagnosed genetic condition, history of a child diagnosed with a genetic condition, or a current pregnancy with a potential or diagnosed genetic condition. A genetic counselor can explain genetic conditions in detail, explore the risk of inheritance, review the potential life course of the condition and provide recommendations and referral for further interventions or testing.

Invasive procedures come with some risks that are explained prior to the procedure being performed.

Cervical Cerclage placement is a surgical procedure used to help close a cervical opening in pregnancies with a history of frequent pregnancy loss due to early cervical dilation or in early pregnancies that meet criteria for the procedure to potentially prolong the pregnancy.

Amniocentesis is a procedure performed after 16 weeks gestation by which the provider uses ultrasound to guide a very thin needle into the amniotic sac and retrieve amniotic fluid which contains fetal cells for testing.

During pregnancy high levels of pregnancy hormones can interfere with how a woman’s body makes and uses insulin to keep her blood sugars in a normal range. Uncontrolled high blood sugars before or during pregnancy can cause fetal abnormalities and can lead to complications such as labor difficulties, birth trauma, cesarean section, baby being born with blood sugar issues that may need special care and an increased risk of stillbirth.

A woman may be referred to Maternal-Fetal Medicine for co-management of gestational diabetes or pre-existing diabetes which may include close monitoring of blood sugar levels, initiation and management of insulin, ultrasound for monitoring of fetal growth and fetal well-being testing (Biophysical Profile and/or Non-Stress Test).

Dr. Muller is an Osteopathic Physician, and can address musculoskeletal pain with manipulation treatment that is safe in pregnant patients:

• Neck and back pain
• Pelvic/hip pain
• Headaches