High Risk Obstetrics

If you are going to be greater than 35 years old at the time of giving birth, you may require additional testing and closer surveillance. If you are going to b e greater than 40 years old, you will require even closer surveillance and the recommendation is delivery by your due date in order to decrease the risk of stillbirth. You will be referred to a genetic counselor and will also follow with a maternal-fetal medicine specialist. In our office, we offer a variety of genetic tests for this sub-population, particularly for Down Syndrome. At 10 weeks of pregnancy, we offer our patients screening for Down Syndrome via non-invasive perinatal testing (NIPT). This is performed at our on-site laboratory via a blood test.
See also... Having a Baby After Age 35
See also... Cell-free DNA Prenatal Screening Test
See also... Prenatal Genetic Testing Chart
See also... Prenatal Genetic Screening Tests

When you are pregnant, sometimes your asthma can worsen. It is important to keep a diary of the frequency of symptoms and medication usage. Your medications may need to be changed. You will follow with a maternal-fetal medicine specialist and sometimes with a pulmonologist if symptoms are severe.

Some women have a history of a preterm loss and they have trouble maintaining a pregnancy. At times they are candidates for a cervical cerclage. In select cases, Dr. Dresdner will place a suture (under anesthesia) at your suture to help lengthen your pregnancy. If it is determined that a physical-exam indicated ("rescue") cerclage is necessary, we are available to perform this procedure on the same day.

Some women develop a pregnancy-caused diabetes. Their bodies simply cannot process sugar like they can when they are not pregnant. Most women are tested between 24-28 weeks, but it is sometimes necessary to test a patient earlier in the pregnancy. Gestational diabetes sometimes can be controlled with a low-carbohydrate diet and mild exercise alone. Sometimes women require medication to help lower their blood sugar (pills or insulin injections). Uncontrolled gestational diabetes can lead to increased risk of macrosomia (larger babies), shoulder dystocia, organ failure, hypoglycemia (low sugar) in the newborn, stillbirth, and increased risk of cesarean section. We offer counseling and close surveillance four our patients with gestational diabetes. Patient need to monitor their sugars four times per day and follow with the maternal-fetal medicine specialist.
See also... Gestational Diabetes

If you have high blood pressure (140/90 or greater) prior to 20 weeks of pregnancy, you have chronic hypertension. You may need to take medications to help control your blood pressure. You should buy a blood pressure cuff to monitor your blood pressure and closely follow instructions given by your provider. If you develop high blood pressure (140/90 or greater) after 20 weeks of pregnancy, you have gestational hypertension. You will need to monitor your blood pressure and be followed closely by your provider and often a maternal-fetal medicine specialist. At times during the third trimester, women develop a condition of the placenta that causes high blood pressure in pregnancy, called preeclampsia. It is often accompanied by protein in urine and can sometimes be associated with headaches, blurry vision, pain in the upper right side of your abdomen, and excessive swelling in the limbs and face. This can be dangerous and if uncontrolled, can lead to other conditions known as eclampsia or HELLP syndrome. Our doctors are well-versed in these conditions and know how to manage them both in and out of the hospital. We will counsel you on signs and symptoms to look for. You will also have to follow with our local maternal-fetal medicine specialist. As these conditions can progress rapidly, you may have to be delivered earlier than expected.
See also... Preeclampsi and High Blood Pressure During Pregnancy

Certain conditions of pregnancy i.e. preeclampsia, can limit your baby's growth and development. If there is a suspicion that your baby is not growing sufficiently, you will follow closely with a maternal-fetal medicine specialist and early delivery may be required.

Many women do not know that unfortunately up to 25% of pregnancies can end in miscarriage. There are different types of miscarriages. With spontaneous miscarriages, all products of conception have been released (typically with bleeding), leaving an empty uterus. Other types of miscarriages may require serial blood tests, medication, or surgical intervention. We are here to offer counseling and support to you and your partner during this difficult time, all while keeping you safe and preparing you for future conception and childbearing.

Whether natural or via assisted reproductive technology (ART/IUI/IVF), our doctors are equipped to handle twins and other multiple gestations. The mode of delivery (vaginal or cesarean section) is dependent on the positions of the babies at the time of birth. Extra prenatal visits and close surveillance by maternal-fetal medicine specialists are required for multiple gestations. We will instruct you on the timeline and plans to ensure the safety of you and your unborn children.
See also... Multiple Pregnancy

If your Body Mass Index exceeds 35, you and your unborn child may be at risk for certain conditions. Your doctor will discuss nutrition and appropriate weight gain during pregnancy. You may require closer surveillance during the pregnancy. If your Body Mass Index exceeds 40, you will follow with a maternal-fetal medicine specialist and are recommended to deliver by your due date to decrease the risk of stillbirth.
See also... Obesity and Pregnancy

Vaginal bleeding in pregnancy could be serious and you should notify your physician if it occurs. In some cases i.e. trauma, car accident, maternal drug use, hypertension in pregnancy, a placenta abruption could occur. This means that the placenta starts to detach early from the wall of the uterus before or during birth. This can compromise your baby's oxygenation and even life and delivery may be prompted immediately. It can also result in a large amount of blood loss for you. In less serious cases, observation in or out of the hospital may be necessary.

If you have had previous cesarean sections, your placenta could invade the uterine wall. This can result in vaginal bleeding and requires close monitoring by your OBGYN provider, a maternal-fetal medicine specialist, and often a pelvic surgeon/gynecology oncologist. A hysterectomy may be necessary immediately after cesarean delivery to limit your blood loss or other complications.

The placenta may lay low or completely cover the cervix. This can result in vaginal bleeding and requires close monitoring by your OBGYN provider and a maternal-fetal medicine specialist. It sometimes can resolve over time but if it doesn't it will be required that you undergo a Cesarean section (typically earlier than your due date). See also... Bleeding During Pregnancy

If your child is born prematurely (between 23 and 37 weeks), they may be at risk for a variety of learning and physical disabilities, as well as problems with breathing at the time of birth. We follow our patients closely, provide counseling and appropriate treatment and services. When necessary, we refer our patients to a perinatologist/maternal-fetal specialist to help ensure that you and your baby remain safe. Of course our goal is to prevent preterm birth, but our doctors are well-trained to deliver and care for premature babies. Please be aware, at times if you show signs of preterm labor (contractions and cervical change prior to 37 weeks) or preterm premature rupture of membranes (breaking your water prior to 37 weeks), you may be required to be admitted to the antepartum unit at Saint Barnabas Medical Center for an extended stay for continuous monitoring of you and your baby.
See also... Extremely Preterm Birth

If you are of reproductive age and considering conception, you and your partner should avoid traveling to Zika endemic regions. If you must travel, you and your partner should take necessary precautions i.e. insect repellant, complete clothing coverage. If you or your partner have recently traveled to a Zika-endemic region, you should discuss with your doctor. Testing is available. Updates readily occur.
See also... Zika Infomation