Maternal-Fetal Medicine (also known as high risk pregnancy) is a sub-specialty within Obstetrics and Gynecology that involves pregnancies at risk for complications (see statement by the Society of Maternal Fetal Medicine SMFM).
According to the SMFM, the discipline of Maternal-Fetal Medicine involves the following conditions and patients:
Obstetric complications
- Recurrent pregnancy loss
- Preterm birth prevention
- Asymptomatic (eg, prior second-trimester loss, possible cervical insufficiency)
- Prior preterm birth
- Mullerian abnormalities
- Short cervical length
- Cervical cerclage
- pessary, progesterone, or other interventions for prevention of PTB
- Symptomatic preterm labor
- Preterm premature rupture of fetal membranes (PPROM)
- Meconium complications
- Malpresentation and malposition
- Shoulder dystocia
- Abnormal third stage of labor
- Placenta accreta, increta, percreta
- Second- or third-trimester vaginal bleeding
- Preeclampsia with severe elements/eclampsia with HELLP syndrome or end-organ damage
- Severe postpartum hemorrhage
- Cesarean hysterectomy
- Acute fatty liver of pregnancy
- Amniotic fluid embolism
MATERNAL COMPLICATIONS
Hypertensive disorders
- Chronic hypertension
- Preeclampsia
- Severe Preeclampsia
- HELLP syndrome
Cardiac disease
- Congenital heart disease
- Arrhythmias
- Valve disease
- Cardiomyopathy
- Pulmonary hypertension
- Coronary artery disease
- Heart transplant
- Cardiac disease (Clark's Group II, III, any valve replacement)
Any antepartum patient admitted for "other than delivery" and patients with postpartum complications
such as
- severe hemorrhage,
- refractory infections,
- complicated preeclampsia,
- eclampsia and
- difficult post cesarean complications
- Eating disorders
- Severe preeclampsia/eclampsia HELLP syndrome
- Substance abuse
- Transplants
Respiratory disease
- Asthma
- Pneumonia
- Restrictive lung disease
- Pulmonary edema
- Influenza
- Tuberculosis
- Cystic fibrosis
Obesity
Endocrinologic disorders
- Addison disease
- Diabetes, insulin-requiring/dependent
- Thyroid disease
- Parathyroid disease
- Pheochromocytoma
Gastrointestinal disease
- Nausea and vomiting in pregnancy; hyperemesis gravidarum
- Eating disorders
- Intrahepatic cholestasis
- Inflammatory bowel disease (ulcerative colitis; Crohn’s disease)
- Gallbladder disease (cholecystitis, cholelithiasis)
- Pregnancy after liver transplantation
- Pancreatitis
- Wilson disease
- Hepatitis
- Acute fatty liver of pregnancy
- Portal hypertension
- Ulcerative colitis
- Crohn's disease
Hematologic diseases
- Maternal anemia and hemoglobinopathies
- Sickle cell disease
- von Willebrand disease
- Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome
- Allo- and autoimmune thrombocytopenia
- Thromboembolic disease, past or current
- Care of the Jehovah’s Witness pregnant woman
- SLE/Other collagen vascular disease
Congenital disorders with potential untoward maternal outcomes:
- Cystic fibrosis
- Marfan's syndrome
- Protein S, C, AT-III deficiency
- Factor 5 Leiden
- Prothrombin mutation
Renal disease (includes renal transplantation)
Neurologic diseases:
- Seizure disorders
- Headache
- Multiple sclerosis
- AV malformation
- Berry aneurysm
- Prolactinoma
- Pseudotumor cerebri
- Myasthenia gravis
- Paraplegia/quadriplegia
- Spinal cord injury
- Diabetes insipidus
Psychosocial issues and abuse
- Smoking
- Alcohol abuse
- Drug abuse
- Depression
- Other psychiatric disorders
- Domestic violence
Rheumatologic disorders
- Antiphospholipid syndrome
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Other autoimmune disease
Thromboembolic disorders
- Venous thromboembolism and anticoagulation
- Inherited thrombophilia
Infectious disorders
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Cytomegalovirus (CMV)
- Toxoplasmosis
- Rubella
- Parvovirus
- Varicella
- Herpes
- Coccidomycosis
- Listeria
- HIV
- Gonorrhea
- Chlamydia
- Syphilis
- Trichomonas
- Group B streptococcus
- Vaccination concerns
- Pyelonephritis
- Management of wound infection
- Other life-threatening infections
Trauma and critical care
- Trauma
- Critical care
- Nonobstetric abdominal surgery in the current pregnancy
Skeletal; connective tissue
- Marfan syndrome
- Maternal skeletal dysplasia
Skin Conditions/Dermatoses
Fetal anomalies
- Structural abnormalities
- Family history of abnormality
- Aneuploidy or increased risk for aneuploidy
- Teratogen exposure
Fetal complications
- Threatened miscarriage (including medical and surgical management)
- Multifetal pregnancies (including, but not limited to, mono/di twins, mono/mono
- twins, higher-order multiples; fetal growth restriction of 1 fetus; twin-twin transfusion
- syndrome; fetal reduction)
- Growth disorders
- Growth restriction
- Macrosomia
- Infections (eg, cytomegalovirus, toxoplasmosis, parvovirus, Herpes, varicella)
- Fetal death
- Hemolytic disease (red cell alloimmunization)
- Neonatal alloimmune thrombocytopenia
- Nonimmune hydrops
- Immune hydrops
Pregnant women with fetuses at markedly increased risk of adverse outcome, such as:
- Abdominal pregnancy
- Abnormal maternal serum testing
- Fetal hydrops; immune, nonimmune
- Fetal anomaly or cytogenetic abnormality
- Fetal supraventricular tachycardia or congenital heart block
- Incompetent cervix
- Red cell alloimmunization
- Mullerian abnormalities
- Multifetal pregnancies (Twins, Triplets, etc)
- Recurrent prior to preterm deliveries
- Nonobstetric abdominal surgery in the current pregnancy
- Oligohydramnios at <37 weeks gestation
- Placenta accreta, increta, percreta
- Polyhydramnios
- Premature rupture of membranes <34 weeks gestation
- Preterm labor <34 weeks gestation
- Prior second trimester fetal loss
- Prior intrauterine fetal demise
- Recurrent pregnancy loss
- Significant 2nd or 3rd trimester bleeding
- Suspected intrauterine growth restriction
- Twin-to-twin transfusion syndrome
Patients undergoing diagnostic or therapeutic procedures, including:
- Abdominal cerclage
- Chorionic villus sampling
- Comprehensive ultrasound
- Fetal gene therapy
- Fetal blood sampling
- Fetal transfusion
- Fetal muscle/organ biopsy
- Fetal reduction
- Fetal skin sampling
- Fetoscopy/embryoscopy
- Genetic amniocentesis
- Other diagnostic/therapeutic procedures
Fetal testing
Antepartum fetal monitoring
Sonographic assessment of amniotic fluid abnormalities
- Oligohydramnios
- Hydramnios
- Fetal blood sampling/intrauterine transfusion
- Screening for fetal anemia
- Fetal muscle/organ biopsy
- Fetal skin sampling
- Fetal surgery; fetoscopy/embryoscopy
Maternal malignant disease
- Cancer of the Ovary
- Cancer of the Cervix
- Cancer of the Endometrium
- Fallopian Tube Cancer
- Breast Cancer
- Other Cancer