High-Risk Pregnancy and Maternal-Fetal Medicine (MFM)

If you have a high-risk pregnancy, you need specialized care. Maybe you've had multiple miscarriages, have a chronic health condition like diabetes, or are 40 years old and having your first baby. If you're at risk for complications in pregnancy, it's important to see a maternal-fetal medicine doctor. 

A maternal-fetal medicine (MFM) doctor is an obstetrician with extra training. They know how to manage difficulties in pregnancy. Our UPMC Magee-Womens MFM experts are among the best in the country and have treated thousands of women with high-risk pregnancies. 

Here's what you need to know about seeing an MFM doctor near you.

What Is MFM?

MFM is a subspecialty of obstetrics and gynecology. An MFM specialist, called a perinatologist, has all the training an obstetrician has, with added education in managing high-risk pregnancies. In other words, every MFM doctor is an obstetrician, but not every obstetrician is an MFM doctor. 

MFM doctors complete a four-year residency in obstetrics and gynecology and a three-year fellowship in perinatology. This training focuses on pregnancy complications and diseases that affect both mother and baby. 

You may continue seeing your regular obstetrician in addition to an MFM doctor throughout your pregnancy, or you may see the MFM doctor from the beginning of your pregnancy if you already have a high-risk condition (like diabetes). You may also get referred to an MFM doctor if problems (like pregnancy-induced high blood pressure) develop later in your pregnancy. 

Your MFM doctor may partner with other specialists. Other members of your medical team may include genetic counselors, neonatal specialists, and nutritionists.

Is maternal-fetal medicine the same as high-risk OB?

Yes, an MFM doctor is the same as a high-risk obstetrician. You may also hear them referred to as perinatologists.

What High-risk Pregnancies Does an MFM Treat?

At UPMC, our MFM doctors treat a wide range of high-risk pregnancy conditions. They work with your regular obstetrician and other care team members to manage these conditions. They'll coordinate care for you and your unborn baby.

You may be referred to an MFM if your ob-gyn suspects that:

• Your baby is likely to be born before 37 weeks gestation.
• Your baby isn't growing well (fetal growth restriction).
• Your baby may have a congenital disability.
• You're carrying twins, triplets, or more multiples. 

Pregnancy complications we treat

Some pregnancy complications appear soon after you find out you're pregnant. Others don't surface until months into the pregnancy.

These are some of the most common complications we treat:

• Amniotic fluid disorders — Too much or too little amniotic fluid.
• Bleeding during pregnancy — Heavy bleeding during pregnancy can indicate a serious problem.
• Cervical insufficiency — When your cervix dilates (opens up) too early. This can cause pregnancy loss or premature delivery, depending on when it happens.
• Ectopic pregnancy — A pregnancy that occurs outside the uterus.
• Fetal growth problems — When the baby's growth gets limited.
• Gestational diabetes — Diabetes that occurs during pregnancy but goes away after you give birth.
• Hyperemesis gravidarum — Extreme vomiting and nausea during pregnancy, which can lead to dehydration, weight loss, and electrolyte imbalances.
• Infections — During pregnancy, some infections can lead to various symptoms and health issues.
• Placenta accreta — A pregnancy condition where the placenta grows too deeply into the uterine wall.
• Placenta previa — A pregnancy condition where the placenta stays in the lower part of your uterus and is too close to the cervix.
• Placental abruption — When the placenta detaches from the uterine wall.
• Preeclampsia — Pregnancy-related high blood pressure, usually after the 20th week of pregnancy.
• Preterm labor — Going into labor before 37 weeks of pregnancy.
• Thyroid problems — Pregnancy-related changes in your thyroid that can lead to miscarriage, preeclampsia, and premature birth. 

Preexisting health conditions we treat

If you already have a health problem when you get pregnant, MFM doctors can help manage your pregnancy. Pregnancy puts an extra strain on every system in your body, and it can make existing conditions worse.

Some of these conditions include: 

• Blood disorders — Such as anemia, sickle cell disease, and blood clotting diseases
• Bone, cartilage, and skin disorders.
• Cancer.
• Digestive problems — Such as inflammatory bowel disease, gallbladder disease, and liver disease.
• Emergencies that require surgery.
• Endocrine and hormone disorders — Including diabetes and thyroid disease.
• Heart disorders — Including coronary artery disease, heart valve problems, and heart rhythm disorders.
• Immune diseases or infections — Such as HIV, hepatitis, and autoimmune diseases.
• Kidney diseases.
• Lung problems — Such as asthma, cystic fibrosis, and lung disease.
• Obesity. 

Will the MFM deliver my baby?

It depends. Usually, your regular obstetrician will deliver your baby. But if your condition warrants it or complications arise, your MFM doctor may also participate in the delivery.

What High-Risk Pregnancy and MFM Services Do You Offer?

We offer a full range of MFM services for your high-risk pregnancy. Our MFM doctors can provide care throughout all stages of pregnancy, from conception to delivery. Regardless of what puts you or your baby at risk, our MFM care team can help you through any potential problems.

Screenings and exams

If you have a high-risk pregnancy, you'll need more frequent checkups than someone with a routine pregnancy. We provide a full range of diagnostic screenings and exams for high-risk pregnancies. 

These screenings and exams include:

• Amniocentesis — This procedure takes a sample of the amniotic fluid that surrounds the fetus. By taking a sample of the fluid, doctors can test for genetic problems or congenital disabilities, such as spina bifida.
• Chorionic villus sampling — This procedure takes a sample of the placenta, which is used for tests to diagnose genetic health conditions like Down syndrome.
• Fetal echocardiogram — This picture of the baby's heart shows doctors if there are any defects in it.
• Maternal serum screen — A blood test identifying an increased risk for congenital disabilities such as neural tube defects or chromosomal disorders.
• Noninvasive pregnancy testing (NIPT) — A screening test for genetic problems in the baby using the mother's blood.
• Specialized ultrasound — If doctors suspect a problem with the fetus, they may perform a 3D or 4D ultrasound.

Specialized services

Our goal is always a healthy pregnancy and delivery.

To reach that goal, we offer services such as:

• Genetic testing and counseling.
• Infertility tests and treatments.
• Minimally invasive gynecologic surgery.
• Diabetes Care and Education
  • A Guide to Diabetes and Pregnancy (PDF).
  • A Guide to Gestational Diabetes Book (PDF).
• Nutritional counseling.
• Preconception counseling.
• Prenatal and postpartum care.

Why Would I See a Maternal-Fetal Medicine Expert?

You should see an MFM doctor if you're at risk for any pregnancy complications. With good prenatal care and modern medical techniques, many women with high-risk conditions can have a healthy pregnancy and delivery. 

Here are some of the most common reasons you might need to see a MFM doctor.

A preexisting medical condition

If you already have a health condition, it can also cause problems with pregnancy. An MFM doctor has experience handling these pregnancies.

Some of these diseases and conditions include: 

• Diabetes.
• Gastrointestinal disease.
• Heart disease.
• High blood pressure.
• HIV.
• Infectious diseases.
• Kidney disease.
• Obesity.
• Thyroid disorders.

Age

Pregnancy risks are higher for women aged 35 and older. They are also higher for teenagers. If you're 17 or younger, your pregnancy is also considered high-risk.

Lifestyle choices

Some habits can put your pregnancy and your overall health at risk.

They include:

• Drinking alcohol. 
• Smoking cigarettes.
• Using illegal drugs.

Medical history

If you've had any of the following conditions or experiences, doctors will consider your pregnancy high-risk:

• A family history of genetic conditions that might affect pregnancy or cause congenital disabilities.
• A low birthweight baby — A previous baby weighing less than 5 pounds, 8 ounces at birth.
• A preterm baby — A previous baby born before 37 weeks of pregnancy.
• A history of pregnancy loss — A pregnancy loss before 20 weeks is a miscarriage. A pregnancy loss after 20 weeks is a stillbirth.
• A history of infant loss — The death of a baby shortly after birth. 

Problems during pregnancy

Your obstetrician may call in MFM experts at any time during your pregnancy.

Some of the most common reasons for re-classifying your pregnancy as high risk include:

• Evidence of possible congenital disabilities.
• Low amniotic fluid or too much amniotic fluid.
• Problems with the uterus, cervix, or placenta.
• Restricted fetal growth.
• Rh (rhesus) sensitization. This potentially serious condition occurs when your blood group is Rh-negative, and your baby's is Rh-positive.
• You develop a health problem (bleeding, preeclampsia, gestational diabetes) while you're pregnant.
• Your baby isn't growing well.
• You're pregnant with multiples (twins, triplets, or more). 

What Should I Expect at My MFM Appointment?

Your first visit to an MFM doctor will depend on why you're seeing them. Women with preexisting health problems may see an MFM doctor before they even start trying to get pregnant. Other women develop a problem (like preeclampsia or gestational diabetes) well into their pregnancies. 

Your regular obstetrician will coordinate care with the MFM team.

They will send the following information to the MFM doctor:

• All your medical records from this pregnancy and previous pregnancies.
• Any recent diagnostic tests or images.
• Any recent lab test results.

If you have a long-term condition you manage at home — like high blood pressure or diabetes — you should bring those logs to your appointment. 

Your MFM doctor may provide ultrasounds, fetal monitoring, and genetic testing. They may counsel you on your baby's conditions and how to care for them. 

It's helpful to write down a list of questions or concerns to bring to your appointment. It's easy to feel overwhelmed when you're worried about your pregnancy, and if you write down questions, you're less likely to forget them.

Your High-risk Pregnancy Care Team

If you have a high-risk pregnancy, your care team can pull from many different areas of expertise.

Team members may include:

When Should I Call the Doctor?

You should call your ob-gyn or MFM doctor right away if you have:

• Bleeding or excess fluid leaking from your vagina.
• Blurred or impaired vision.
• Contractions before 37 weeks that occur more than four times in 20 minutes or more than eight times an hour for over an hour.
• Prolonged or excessive vomiting.
• Severe headache.
• Unusual or severe belly pain or cramps.

Why Choose UPMC for High-Risk Pregnancy Care?

Our expert MFM doctors and care team are among the best in the nation, if not the world. We have been nationally ranked for excellence in women's care. Our Division of Maternal-Fetal Medicine provides total prenatal care and consultations by a team of national and global MFM experts. 

Our woman-centered approach brings together a full range of experts, depending on your condition. That includes MFM doctors, ob-gyns, and other experts to provide cutting-edge care for women with high-risk pregnancies.

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By UPMC Editorial Staff. Last reviewed on 2024-09-05 by Sami P. Makaroun, MD.