Seamless, Coordinated Care:
High-Risk Pregnancy Management
All Under One Roof
Tucked away in a quiet corner of the Froedtert & Medical College of Wisconsin Birth Center, a specialty clinic combines the most advanced technology available with basic human compassion to help couples deal with one of life's most worrisome events — a high-risk pregnancy. Staffed by physicians trained in high-risk obstetrics, nurse coordinators and genetic counselors, the Froedtert & Medical College of Wisconsin Maternal Fetal Care Center provides hopeful parents-to-be with a full spectrum of services — from pre-conception counseling to a wide range of advanced testing — all in one location.
A pregnancy is considered high risk when a condition or circumstance could affect the health of the mother or baby. About 6 percent to 8 percent of all pregnancies are called high-risk. A wide range of contributing factors define this category — some of them predictable. Some women know they’ll need specialty care during pregnancy because of a chronic medical condition, such as diabetes, a complication in a previous pregnancy, such as pre-term birth, a family history of hereditary disease or birth defects, or advanced maternal age (35 or older). Other examples include preeclampsia (a form of high blood pressure) and multiple gestations. Concerns about the baby's health, from a suspected fetal anomaly to an in-utero medical condition, also complicate a pregnancy.
Although these factors are serious, much can be done to treat and manage a high-risk pregnancy, says Dwight Cruikshank, MD, Medical College of Wisconsin obstetrician/gynecologist and chairman of Obstetrics and Gynecology. "Early diagnostic testing helps us identify high-risk pregnancies and determine treatment options," he explains. "By being prepared and providing early, coordinated care, we can improve outcomes."
The Maternal Fetal Care Center offers a range of routine tests, including assessments, screenings, ultrasound and umbilical cord sampling. It also offers chorionic villus sampling as early as the 10-13th week of pregnancy and amniocentesis is performed around the 15-16th week. Both diagnostic tests detect chromosomal abnormalities and genetic disorders. Amniocentesis involves removing a small amount of amniotic fluid under ultrasound guidance. Specimens obtained from these procedures are sent to highly specialized laboratories for evaluation. And the Center is one of the first to use four-dimensional (4D) ultrasound from GE Medical Systems. In addition to showing a fetus from all sides, 4D shows real-time movement in utero.
The Center is certified to perform a highly sophisticated ultrasound called nuchal translucency screening. The test measures the fluid under the skin behind the neck of the fetus during the first trimester. Results can determine if the fetus is at increased risk for chromosomal abnormalities like Down syndrome, Trisomy 13 and 18, as well some cardiac defects and many genetic syndromes.
Women who have pre-existing conditions should seek testing and counseling before becoming pregnant, says Thomas Wigton, MD, Medical College of Wisconsin perinatologist. "We often work with a woman's doctor to make sure conditions such as diabetes are under control so the mother's physical health is optimal before she gets pregnant. If the mother has a condition that may be hereditary, she can meet with our genetic counselor to determine whether her fetus might be affected."
As a type 1 diabetic, Amy Lukas sought care before she became pregnant. "Dr. Wigton told us what to expect during pregnancy. He explained how he would work with my endocrinologist to maintain insulin levels throughout the pregnancy." Lukas experienced two miscarriages before becoming pregnant for the third time. That pregnancy proceeded normally until the 28th week, when she developed mild preeclampsia. Her condition was carefully monitored to keep Lukas' blood pressure under control. She delivered a healthy 7 lb., 11 ounce baby boy in her 38th week. "Diabetics often have big babies, but my son Jonathan's weight was average. I attribute that to the care I received from Dr. Wigton and his team," says Lukas.
Ann Flad-Jesion also sought preconception counseling through the Maternal Fetal Care Center, because she experienced preeclampsia that lead to the pre-term birth of her now 3-year-old son.
Reassured, she soon became pregnant. She didn't develop preeclampsia, but a rare condition – Rh factor incompatibility — was discovered through early blood work. When a mother's blood type is Rh negative and she carries a fetus with Rh positive blood type, the incompatibility stimulates production of a maternal antibody that attacks the baby's red blood cells. That can lead to anemia, jaundice or death of the baby. An effective immunization treatment is available and although Flad-Jesion received it, for an unknown reason, it failed.
Flad-Jesion's physician, Mary Ames Castro, MD, Medical College of Wisconsin perinatologist, performed ultrasound exams throughout the pregnancy to monitor fetal growth and brain-blood velocity, indicators of the effect Rh incompatibility may be having on a baby's health.
Toward the end of the pregnancy, amniocentesis was used to measure other indicators and determine if the baby's lungs were sufficiently developed for birth.
"At 36 weeks, I had an amnio at eight in the morning that showed my baby was starting to get sick," says Flad-Jesion. "But my doctors were confident the baby’s lungs were in good shape, so at five that night, we had our baby."
Lukas and Flad-Jesion delivered at the Froedtert & Medical College of Wisconsin Birth Center. Located within Children's Hospital of Wisconsin, the center has immediate access to Children's state-of-the-art neonatal intensive care unit and a full range of pediatric medical and surgical care. Its advanced capabilities eliminate the need for transfers to other facilities whatever the complications — and provide additional assurance to parents.
Says Flad-Jesion, "Because of our experience with the pre-term birth of our first child, we wanted to be near a neonatal intensive care unit in case of complications."
Coordinated, seamless care throughout pregnancy and delivery can have a tremendous effect on outcome. "A remarkable amount of medical literature indicates when complications are diagnosed in utero and babies are delivered at a tertiary care center that offers coordinated care, they do much better," says Dr. Ames Castro.
Coordinated care is important in the treatment women receive at the Fetal Concerns Program, a collaborative effort of Froedtert & Medical College of Wisconsin and Children's Hospital of Wisconsin. It's the first of its kind in the state to provide a complete range of care for parents expecting a child with a serious diagnosis. "We take care of the mom and connect parents with subspecialty care the baby may need immediately after birth," says Steven R. Leuthner, MD, Medical College of Wisconsin perinatologist and co-director with Dr. Wigton of the program. "We also offer support for the family." The program also links families to support services during the child's first year of life.
Emotional support and much more is provided by nurse coordinators at the Maternal Fetal Care Center. They perform a broad range of duties from helping patients set up appointments and managing health insurance to coordinating lab work and conducting tests.
According to Patient Care Supervisor Mary Pipkin, RN, helping patients deal with stress and anxiety is a critical part of the job."We become very close to our patients and they feel more comfortable knowing they can always call us with any questions."
Adds Amy Lukas, "It can make you very nervous knowing your pregnancy might have complications, so you need to feel comfortable with your care. I can't say enough about the Center's whole team, from the doctors to the nurses. Weeks after the birth of my daughter, my doctor was still calling to see how things were going.
Source: Froedtert Today
Date: December 2005