Managing Medical Conditions During Pregnancy
Mary Ames Castro, MD
Medical College of Wisconsin Perinatologist
Most routine pregnancies are handled by an obstetrician or primary care physician. But when complications are anticipated due to the mother's medical history, or if they emerge during the pregnancy and threaten the health of the fetus or mother, a specialist in maternal-fetal health called a perinatologist may be required. Perinatologist Mary Ames Castro, MD, talks about the importance of maternal fetal assessment and coordinated care in complicated pregnancies.
Q. What is a maternal fetal assessment and when is it required?
Maternal fetal assessment is a comprehensive look at a pregnant mother and her baby. The assessment may be performed because of a medical complication with the mother, with the baby or with both. Through examinations and diagnostic procedures, such as ultrasound, we follow mother and baby throughout the pregnancy. We then co-manage the patient with her doctor or, in some instances, a woman's doctor may transfer all of her care to us. Most of these are high-risk pregnancies.
The assessment may be needed whenever there is any medical concern relating to the mother or baby. Often, these are chronic medical conditions in the mother, such as diabetes or hypertension that can also affect the baby. Or the mother may be expecting multiple births. The mother may have a cardiac problem, such as a congenital heart defect, or a family history of diseases with a genetic basis. She would see me or one of three other perinatologists at Froedtert & Medical College of Wisconsin, along with a genetic counselor to determine the possibility of her fetus being affected. In most situations, we also work with other healthcare providers, such as a cardiologist, to manage her condition.
Ideally, we see a woman with a chronic medical condition before she gets pregnant. We want to make sure conditions such as diabetes are controlled and stabilized, or that a heart defect is repaired, so that the mom's condition is optimal before she gets pregnant.
Q. What is the role of the perinatologist in maternal fetal assessment?
In addition to obstetric and gynecology training, a perinatologist has completed a three-year clinical and research fellowship. We have advanced training in comprehensive diagnostic ultrasound imaging and other complicated procedures. The knowledge we gain through these procedures helps us provide therapeutic management of the mother’s condition, and can also lessen the risk of pre-term birth of the baby. Additionally, we have knowledge of all of the other fields of medicine that we may need to access. One of the most important things we do is coordinate care among other members of the mother’s healthcare team. We also coordinate delivery with the neonatal team in case the baby needs specialized care immediately after birth.
Q. Why is coordinated care so important?
A remarkable amount of medical literature indicates that when babies are diagnosed in utero and delivered at a tertiary care center that offers coordinated care, they do much better. We have also found that in situations where the baby may have anomalies or be at risk for pre-term birth, or if the mother has a medical condition, it is better for mom/baby to be transported before birth, versus after the baby is born. Providing coordinated care for mother and baby at one location can have a tremendous impact on outcome.
Froedtert & Medical College of Wisconsin, in a cooperative effort with Children's Hospital of Wisconsin, offers all the subspecialty care a mother and baby may need. We were one of the first in the country to put together these combined services and it is the only program of its type in the state. It's really quite phenomenal that this service is available in Wisconsin. Patients not only come from all over the state, but also from all over the country, to take advantage of it.
Coordinated Care for Babies, Parents and FamiliesPregnancy is a special time filled with hopes and plans as parents look forward to the birth of their baby. But when concerns arise over the health of the fetus, pregnancy can become a time of confusion and worry. Since 2000, families in Wisconsin and throughout the country have turned to the Froedtert & Medical College Fetal Concerns Program for a full spectrum of medical services, all in one location. In cooperation with Children's Hospital of Wisconsin, the program offers health services, education and counseling for parents expecting a child with a serious diagnosis, such as spina bifida or a cardiac complication. The program's main goals are to reduce stress and anxiety, while developing a plan of complete coordinated care. Specially trained nurse coordinators arrange for all services and provide ongoing support.
"We take care of the mom from an obstetrics standpoint, hook the family up with any subspecialty care the baby may need, and help them make decisions regarding labor and delivery," says Steven R. Leuthner, MD, Medical College of Wisconsin perinatologist and co-director of the program. Parents often choose to deliver at the Froedtert & Medical College of Wisconsin Birth Center, located within Children's Hospital, where advanced neonatal care is available immediately. The program also provides connections to support services during the child's first year of life.
For more information on the Fetal Concerns Program, call 414-805-3666 or 800-272-3666.