UCHealth Maternal Fetal Medicine Clinic - Anschutz Medical Campus

If you have a chronic medical condition or are on medications, the best time to discuss this is before you are pregnant. A preconception visit allows the maternal fetal medicine doctor to review your history and medications to make recommendations on when it is safest to get pregnant, which medications are safe to take during pregnancy, and if you should switch medications before you try to get pregnant.

If you have a medical condition and are on medications, and unexpectedly find out you are pregnant, don’t stop your medications without talking to your OB provider. Many medications can be safely taken during pregnancy and it may be unsafe to stop them. Our MFM physicians will work with you and your primary doctors to get you on the safest, most effective medications and treatments during pregnancy.

In your consultation with the MFM physician, they will review your history and current health to help to determine future pregnancy risks. For several conditions, such as history of preterm birth or preeclampsia, there are treatments during pregnancy that can be offered to reduce your risk of recurrence. In other cases, such as with type 1 and 2 diabetes or chronic hypertension, there may be strategies to undertake before getting pregnant that can improve your chance for a healthy pregnancy and baby. Our MFM physicians will help you and your primary OB design a treatment strategy for your unique care.

The American College of Obstetricians and Gynecologists now recommends that women of all ages be offered first- and second-trimester screening and diagnostic testing options.

Ultrasound uses sound waves at much higher frequencies than humans can hear to obtain images of your fetus. There has been widespread use of ultrasound in obstetrics for many years with no harmful effects seen. In addition, research studies in humans have shown no link between ultrasound and any birth defects or poor pregnancy outcomes. Current information shows that the benefit of information we can obtain by ultrasound far outweighs any risks.

Our MFM physicians are happy to meet with you to review your case and discuss pregnancy management and delivery planning. We recommend that you have all of your medical records available, and we may recommend additional testing or ultrasounds at your appointment.

Our MFM physicians will work closely with your main provider (OB doctor, family medicine doctor, or midwife) to determine where it will be the safest for you to deliver with your pregnancy condition. This will depend on if your baby will be born prematurely and need neonatal intensive care or if you need specialized delivery or postpartum care. Our goal is to help you deliver in the safest, most comfortable environment possible for you and your family.

We offer a trial of labor after cesarean (TOLAC) to patients who have had 1 or 2 previous cesarean sections who meet select safety criteria. If your OB provider or hospital does not offer TOLAC, you can transfer your prenatal care to our team for TOLAC at University of Colorado Hospital.

You and your baby will have a thorough evaluation, likely including ultrasound and MRI, to get as much information as possible. After this evaluation, you and your family will have a multidisciplinary meeting with the MFM physicians as well as the pediatric specialists who will be taking care of your baby after delivery. For example, if your baby has a heart condition, the pediatric cardiologists and/or cardiac surgeons will meet with you to discuss the care your baby will likely need and outcomes that can be expected. Learn more about the Colorado Fetal Care Center.

MRI uses magnet technology to take images of your fetus in a noninvasive manner. It can provide detailed images of the fetal brain and is used in addition to ultrasound if there are suspected brain or spinal abnormalities. This will help to obtain additional information for diagnosis and treatment plans.

You and your baby will have access to all of the region’s top medical specialists at University of Colorado Hospital and Children’s Hospital Colorado. If your baby needs intensive care after birth, he or she may be transferred to the neonatology team and stay in one of our state-of-the-art NICUs.

The American College of Obstetricians and Gynecologists now recommends that women of all ages be offered first-and second-trimester screening and diagnostic testing options. Your practitioner, our perinatologist, nurse, or genetic counselor may have discussed the pros and cons of the available approaches with you. But ultimately, whether or not to test is a personal decision.

Many women opt for screening and then make a decision about diagnostic testing based on the initial results. Other women opt for diagnostic testing right away. (They may know that they’re at high risk for a chromosomal problem or a condition that can’t be detected by screening — or they may just feel that they want to know as much as possible about their baby’s condition and are willing to live with the small risk of miscarriage to find out.) Some women decide to have no screening or testing.

If you opt for screening first, you can then decide — with the help of your practitioner, perinatologist, nurse, or genetic counselor — whether your results indicate a high enough risk that you want to have CVS or amniocentesis to determine whether a problem exists. You’ll need to weigh your need to know about your baby’s condition against the small chance that diagnostic testing could cause a miscarriage.

There’s no one right decision. Individual parents-to-be have different feelings about what risks are acceptable and may arrive at different conclusions when facing the same set of circumstances.

Both tests can tell you whether your baby has a chromosomal problem or certain genetic disorders.

CVS is done earlier in pregnancy (usually between 11 and 13 weeks), so you can find out sooner about your baby’s condition and chromosome makeup. If everything’s okay, your mind will be put at ease that much sooner. Or, if there is a serious problem and you opt to interrupt the pregnancy, you’ll be able to do so while you’re still in the first trimester.

On the other hand, you may prefer to wait for the results from second-trimester screening before having an invasive test. At that point, amniocentesis would be your only option.

Other considerations may influence your decision as well. For example, if you’re at high risk for having a baby with a spinal defect, a special ultrasound exam should exclude the diagnosis without the need for an amniocentesis.

CVS is generally thought to have a slightly higher miscarriage rate than amniocentesis.

Before making a decision, you, may want to discuss all of these issues with your partner, your health practitioner, and possibly a genetic counselor.

Amniocentesis and CVS are used to detect:

• Nearly all chromosomal disorders, including Down syndrome, trisomy 13, trisomy 18, and sex chromosome abnormalities (such as Turner syndrome and Klinefelter syndrome). Amniocentesis is more than 99 percent accurate in diagnosing these conditions.
• Several hundred genetic disorders, such as cystic fibrosis, sickle cell disease, and Tay-Sachs disease. The test is not used to look for all of them, but if your baby is at increased risk for one or more of these disorders, in most cases amniocentesis can usually tell you whether he/she has the disease.

Amniocentesis does not detect birth defects such as heart malformations or a cleft lip or palate. However, many structural defects can be picked up on the second-trimester ultrasound that’s routinely done for every woman having an amniocentesis.

Some factors to consider include:

Down syndrome screening results. You had a screening test that indicated your baby is at a higher than average risk for Down syndrome or another chromosomal problem.

Ultrasound results. An early ultrasound showed that your baby has structural defects associated with a chromosomal problem.

Carrier screening results. You and your spouse are carriers of a recessive genetic disorder such as cystic fibrosis or sickle cell disease.

Your history. You’ve previously been pregnant with a child with a genetic abnormality and may have a higher risk of this happening again.

Your family history. You or your partner has a chromosomal abnormality or genetic disorder or a family history that puts your child at increased risk for genetic problems.

Your age. Anyone can have a baby with a chromosomal abnormality, but the risk rises with the mother’s age. For example, your likelihood of carrying a baby with Down syndrome ranges from about 1 in 1295 at age 20 to 1 in 82 at age 40.