Selected Podcast
Maternal Fetal Medicine and Routine OB Care: Understanding the Difference
Dr. C. Brennan Fitzpatrick discusses what a maternal fetal medicine specialist is, what conditions or complications could constitute a high-risk pregnancy, and why the care provided by an MFM different from my Obstetrical Care provider.
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Learn more about C. Brennan Fitzpatrick, MD, MBA
C. Brennan Fitzpatrick, MD, MBA, FACOG
C. Brennan Fitzpatrick, MD, MBA, FACOG is the Director of Perinatal Medicine and Ultrasound, The Women's Hospital.Learn more about C. Brennan Fitzpatrick, MD, MBA
Transcription:
Melanie Cole (Host): Welcome. Today, we’re talking about maternal fetal medicine and routine OB care. We’re learning the difference between what those are and we’re going to learn about high-risk pregnancy today, as well. My guest, is Dr. Brennan Fitzpatrick. He’s the Director of Perinatal Medicine and Ultrasound at Deaconess, the Women’s Hospital. Dr. Fitzpatrick, thank you so much for joining us today. Tell us what is a Maternal Fetal Medicine Specialist. What do you focus on?
Brennan Fitzpatrick, MD, MBA, FACOG (Guest): Thank you so much for having me. A Maternal Fetal Medicine Specialist or Maternal Fetal Medicine as a subspecialty of obstetrics and gynecology, is a physician who completes a four year obstetrics and gynecology residency and then can seek three years of additional training to care for high risk pregnancies.
Host: Well, then let’s talk about high-risk pregnancy. What conditions or complications would constitute a high-risk pregnancy?
Dr. Fitzpatrick: So, high-risk pregnancy is a pregnancy that is at higher risk of experiencing complications both with mother and or baby. Some high-risk that affect mothers include high blood pressure, diabetes, autoimmune diseases such as lupus. Fetal conditions or conditions that affect the baby include diagnosis and management of birth defects, congenital infections, congenital anemia. Patients can also have issues that are associated with the pregnancy itself such as multiple gestation, twins, triplets, et cetera, pre term birth, preeclampsia which is a high blood pressure disease we see just during pregnancy and things like severe bleeding at or around the time of delivery also would be a high-risk issue.
Host: These are so scary, and I was somebody who with my first child had a high-risk pregnancy; tell us a little bit about how it affects a woman’s care throughout the pregnancy. We used to hear a lot about women having to go to bed while they were pregnant and is that still something that happens? Tell us a little bit about what happens for the woman when she is told that this is a high-risk pregnancy.
Dr. Fitzpatrick: You know, certainly the management is going to vary based on the specific condition that we are dealing with. It’s interesting because in reality, we used to talk a lot about bedrest and the most recent studies that have looked at bedrest and virtually almost every condition have shown that it tends not to be of benefit. So, for women who are experiencing high-risk pregnancy, a lot of it is really about putting strategies in place to reduce risk. And you want to select strategies that have been shown via looking at strategies through different types of studies, that show benefit.
And a lot of that has to do with surveillance. So, if we are dealing with moms with diabetes; it’s making sure that their blood sugars are under good control. In patients that have chronic high blood pressure; it’s about monitoring that blood pressure and ensuring that the patient doesn’t develop signs or symptoms of things like preeclampsia. In issues where we see a baby small or has other specific issues that we are monitoring that baby to try to ensure that we’re reducing the risk of stillbirth. So, really the experience that a mom will have during her pregnancy is in a very real way going to be determined by the type of issue that she has.
Host: And what about for baby, Dr. Fitzpatrick. Obviously, as you said, it depends on the condition but women with a high-risk pregnancy are really concerned about preterm labor and as you said stillbirth, God forbid; so if a woman has diabetes or high blood pressure, what should she be concerned about for the baby?
Dr. Fitzpatrick: Well I think the thing about diabetes in particular is that we talk about risks associated with diabetes and there’s no question that patients who have both pregestational diabetes which is diabetes that exists prior to the pregnancy as well as gestational diabetes; that those patients are at higher risk for complications both maternal and fetal. But from a baby perspective, we do know that if patients have good control, that those risks can be as low as they would be for a patient that doesn’t have diabetes. We can never completely eliminate risk, but we can certainly reduce risk.
I think from the standpoint of dealing with chronic hypertension or patients that ultimately develop preeclampsia; that in those particular cases, you really get concerned that you are going to be in a position where you have to deliver the baby preterm. And that inherently has its own risks, and, in those cases, you are trying to do everything that you can to optimize the baby for delivery. Sometimes that includes giving moms steroids to help the baby’s lung mature. Sometimes it involves giving a medicine called magnesium sulfate which is thought to reduce the risk of cerebral palsy in babies that are born less than 32 weeks. So, there’s no question that with those specific issues that we look at risks and like I said, our job is really to put strategies in place to reduce it.
Host: Then tell us about some of those strategies. What kinds of services are available both for normal and high-risk pregnancies through your group?
Dr. Fitzpatrick: So, we really only see high-risk pregnancies. I will say that we do provide a pretty broad scope of ultrasound for the routine and a lot of the docs will access us for that and we have a very robust ultrasound department, but our primary focus is on high-risk services. And those services really entail prenatal diagnosis which is really trying to identify at risk babies while they are in utero so that we can provide management options for those patients and we use ultrasound technology to screen babies for birth defects. A specially trained group of individuals called genetic counselors which help us to kind of counsel patients with respect to genetic risks during the pregnancy so, genetic counseling services, ultrasound. We do a full array of prenatal diagnostic procedures and that accounts for probably 30-40% of what we do.
We provide counseling and management strategies for moms that have underlying issues as we talked about before. We do a lot of management of inpatient pregnancies so pregnancies that have been complicated by preterm labor or preterm premature rupture of the membranes and where the amniotic sac has ruptured and so the womb is essentially open to the world and those sort of have a special set of risks that we have to account for and obviously patients with hypertensive disease in pregnancy with preeclampsia, we’ll manage those patients as inpatients.
We do, do deliveries. We don’t do as much as most general OB providers do because the patients that we are seeing tend to be more complicated. We really do try to strive to get patients delivered if we can in their own community with the physician that they have been seeing in many cases, for the span of their lifetime. So, I think for us, it is like I said, primarily focused on management of those high-risk issues that we see during pregnancy.
Host: Well thank you for clearing that up Dr. Fitzpatrick about how the care provided by a Maternal Fetal Medicine Specialist is different from obstetrical care. So, why is it important that they are under the care of both physicians? Tell us how you work together.
Dr. Fitzpatrick: I think it’s a great question and I think it’s the question that I think patients most commonly ask. We work really, really closely with the obstetrical care providers. Their job is really to identify high-risk issues in pregnancy. To identify those patients that need Maternal Fetal Medicine Specialists involved in their care and as I’ve said before, our job is to put strategies in place to reduce risks. Sometimes we’re able to just define a plan for the obstetrical care provider to follow. Sometimes we comanage throughout the pregnancy with the obstetrical care provider to provide appropriate surveillance. Rarely, like I said, we’ll assist with difficult deliveries and as I said before, the goal is always to have patients maintain a close relationship with their OB provider and for the primary OB providers to deliver their patients.
The other thing that we tend to be involved with and help the obstetrical care providers with is a lot of times there are some extremely difficult cases that come up. Some cases in which a baby has a significant birth defect that we will go ahead and assume care of the patient for their routine prenatal care and in many of those cases, the patient will deliver at a center with surgeons who are able to correct the birth defect or subspecialists that can address some very sophisticated and complex issues and then what we do is work to get those patients back with their general OB Providers.
Host: Wow. So much great information and like I said, it can be such a scary time for families. Tell us what you would like us to know, what you want the take home message to be about Maternal Fetal Medicine and what you can do for women. Give us your best advice.
Dr. Fitzpatrick: There’s no question that parents really expect that when they go through a pregnancy, that everything is going to go perfectly and then you end up in your primary OB’s office and the OB says we’ve identified this issue or that we think that this is an issue. And I think that that just increases anxiety exponentially and I think that can be really, really, really challenging for patients.
And I think what we want to do is not only to help patients get through the pregnancy and sort of be on top of those high-risk issues; but also to reduce anxiety and provide that level of support, I think even in the setting of a high-risk pregnancy; patients need to know that the highest probability outcome is the successful pregnancy and so, from that perspective, I think we really want to work hard to ease anxiety and to provide support in a way that sort of help patients get through the pregnancy and understand that again, in all likelihood, they are going to be successful.
Host: What important work that you do Dr. Fitzpatrick. Thank you so much for joining us today and sharing your expertise. That wraps up this episode of The Women’s Hospital--a Place for All Your life. To schedule an appointment and to learn more about high-risk pregnancy and Tristate Perinatology at the Women’s Hospital head on over to our website at www.deaconess.com/TSP for more information and to get connected with one of our providers.
If you found this podcast informative, please share with other couples that you know, share on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.
Melanie Cole (Host): Welcome. Today, we’re talking about maternal fetal medicine and routine OB care. We’re learning the difference between what those are and we’re going to learn about high-risk pregnancy today, as well. My guest, is Dr. Brennan Fitzpatrick. He’s the Director of Perinatal Medicine and Ultrasound at Deaconess, the Women’s Hospital. Dr. Fitzpatrick, thank you so much for joining us today. Tell us what is a Maternal Fetal Medicine Specialist. What do you focus on?
Brennan Fitzpatrick, MD, MBA, FACOG (Guest): Thank you so much for having me. A Maternal Fetal Medicine Specialist or Maternal Fetal Medicine as a subspecialty of obstetrics and gynecology, is a physician who completes a four year obstetrics and gynecology residency and then can seek three years of additional training to care for high risk pregnancies.
Host: Well, then let’s talk about high-risk pregnancy. What conditions or complications would constitute a high-risk pregnancy?
Dr. Fitzpatrick: So, high-risk pregnancy is a pregnancy that is at higher risk of experiencing complications both with mother and or baby. Some high-risk that affect mothers include high blood pressure, diabetes, autoimmune diseases such as lupus. Fetal conditions or conditions that affect the baby include diagnosis and management of birth defects, congenital infections, congenital anemia. Patients can also have issues that are associated with the pregnancy itself such as multiple gestation, twins, triplets, et cetera, pre term birth, preeclampsia which is a high blood pressure disease we see just during pregnancy and things like severe bleeding at or around the time of delivery also would be a high-risk issue.
Host: These are so scary, and I was somebody who with my first child had a high-risk pregnancy; tell us a little bit about how it affects a woman’s care throughout the pregnancy. We used to hear a lot about women having to go to bed while they were pregnant and is that still something that happens? Tell us a little bit about what happens for the woman when she is told that this is a high-risk pregnancy.
Dr. Fitzpatrick: You know, certainly the management is going to vary based on the specific condition that we are dealing with. It’s interesting because in reality, we used to talk a lot about bedrest and the most recent studies that have looked at bedrest and virtually almost every condition have shown that it tends not to be of benefit. So, for women who are experiencing high-risk pregnancy, a lot of it is really about putting strategies in place to reduce risk. And you want to select strategies that have been shown via looking at strategies through different types of studies, that show benefit.
And a lot of that has to do with surveillance. So, if we are dealing with moms with diabetes; it’s making sure that their blood sugars are under good control. In patients that have chronic high blood pressure; it’s about monitoring that blood pressure and ensuring that the patient doesn’t develop signs or symptoms of things like preeclampsia. In issues where we see a baby small or has other specific issues that we are monitoring that baby to try to ensure that we’re reducing the risk of stillbirth. So, really the experience that a mom will have during her pregnancy is in a very real way going to be determined by the type of issue that she has.
Host: And what about for baby, Dr. Fitzpatrick. Obviously, as you said, it depends on the condition but women with a high-risk pregnancy are really concerned about preterm labor and as you said stillbirth, God forbid; so if a woman has diabetes or high blood pressure, what should she be concerned about for the baby?
Dr. Fitzpatrick: Well I think the thing about diabetes in particular is that we talk about risks associated with diabetes and there’s no question that patients who have both pregestational diabetes which is diabetes that exists prior to the pregnancy as well as gestational diabetes; that those patients are at higher risk for complications both maternal and fetal. But from a baby perspective, we do know that if patients have good control, that those risks can be as low as they would be for a patient that doesn’t have diabetes. We can never completely eliminate risk, but we can certainly reduce risk.
I think from the standpoint of dealing with chronic hypertension or patients that ultimately develop preeclampsia; that in those particular cases, you really get concerned that you are going to be in a position where you have to deliver the baby preterm. And that inherently has its own risks, and, in those cases, you are trying to do everything that you can to optimize the baby for delivery. Sometimes that includes giving moms steroids to help the baby’s lung mature. Sometimes it involves giving a medicine called magnesium sulfate which is thought to reduce the risk of cerebral palsy in babies that are born less than 32 weeks. So, there’s no question that with those specific issues that we look at risks and like I said, our job is really to put strategies in place to reduce it.
Host: Then tell us about some of those strategies. What kinds of services are available both for normal and high-risk pregnancies through your group?
Dr. Fitzpatrick: So, we really only see high-risk pregnancies. I will say that we do provide a pretty broad scope of ultrasound for the routine and a lot of the docs will access us for that and we have a very robust ultrasound department, but our primary focus is on high-risk services. And those services really entail prenatal diagnosis which is really trying to identify at risk babies while they are in utero so that we can provide management options for those patients and we use ultrasound technology to screen babies for birth defects. A specially trained group of individuals called genetic counselors which help us to kind of counsel patients with respect to genetic risks during the pregnancy so, genetic counseling services, ultrasound. We do a full array of prenatal diagnostic procedures and that accounts for probably 30-40% of what we do.
We provide counseling and management strategies for moms that have underlying issues as we talked about before. We do a lot of management of inpatient pregnancies so pregnancies that have been complicated by preterm labor or preterm premature rupture of the membranes and where the amniotic sac has ruptured and so the womb is essentially open to the world and those sort of have a special set of risks that we have to account for and obviously patients with hypertensive disease in pregnancy with preeclampsia, we’ll manage those patients as inpatients.
We do, do deliveries. We don’t do as much as most general OB providers do because the patients that we are seeing tend to be more complicated. We really do try to strive to get patients delivered if we can in their own community with the physician that they have been seeing in many cases, for the span of their lifetime. So, I think for us, it is like I said, primarily focused on management of those high-risk issues that we see during pregnancy.
Host: Well thank you for clearing that up Dr. Fitzpatrick about how the care provided by a Maternal Fetal Medicine Specialist is different from obstetrical care. So, why is it important that they are under the care of both physicians? Tell us how you work together.
Dr. Fitzpatrick: I think it’s a great question and I think it’s the question that I think patients most commonly ask. We work really, really closely with the obstetrical care providers. Their job is really to identify high-risk issues in pregnancy. To identify those patients that need Maternal Fetal Medicine Specialists involved in their care and as I’ve said before, our job is to put strategies in place to reduce risks. Sometimes we’re able to just define a plan for the obstetrical care provider to follow. Sometimes we comanage throughout the pregnancy with the obstetrical care provider to provide appropriate surveillance. Rarely, like I said, we’ll assist with difficult deliveries and as I said before, the goal is always to have patients maintain a close relationship with their OB provider and for the primary OB providers to deliver their patients.
The other thing that we tend to be involved with and help the obstetrical care providers with is a lot of times there are some extremely difficult cases that come up. Some cases in which a baby has a significant birth defect that we will go ahead and assume care of the patient for their routine prenatal care and in many of those cases, the patient will deliver at a center with surgeons who are able to correct the birth defect or subspecialists that can address some very sophisticated and complex issues and then what we do is work to get those patients back with their general OB Providers.
Host: Wow. So much great information and like I said, it can be such a scary time for families. Tell us what you would like us to know, what you want the take home message to be about Maternal Fetal Medicine and what you can do for women. Give us your best advice.
Dr. Fitzpatrick: There’s no question that parents really expect that when they go through a pregnancy, that everything is going to go perfectly and then you end up in your primary OB’s office and the OB says we’ve identified this issue or that we think that this is an issue. And I think that that just increases anxiety exponentially and I think that can be really, really, really challenging for patients.
And I think what we want to do is not only to help patients get through the pregnancy and sort of be on top of those high-risk issues; but also to reduce anxiety and provide that level of support, I think even in the setting of a high-risk pregnancy; patients need to know that the highest probability outcome is the successful pregnancy and so, from that perspective, I think we really want to work hard to ease anxiety and to provide support in a way that sort of help patients get through the pregnancy and understand that again, in all likelihood, they are going to be successful.
Host: What important work that you do Dr. Fitzpatrick. Thank you so much for joining us today and sharing your expertise. That wraps up this episode of The Women’s Hospital--a Place for All Your life. To schedule an appointment and to learn more about high-risk pregnancy and Tristate Perinatology at the Women’s Hospital head on over to our website at www.deaconess.com/TSP for more information and to get connected with one of our providers.
If you found this podcast informative, please share with other couples that you know, share on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.