Long Island Baby - Maternal Fetal Medicine
Maternal Fetal Medicine
Each year in Good Samaritan’s Birthplace, 3,000 infants are welcomed into the world. A talented group of physicians, nurses and support staff take care of each mother and their newborn’s well -being. Their mission to provide excellent, compassionate care in a family-centered and developmentally supportive environment, without having to travel, remains the foundation of this important department. There are times when even extra care is needed during some pregnancies. Good Samaritan’s Center for Maternal Fetal Medicine, part of the hospital’s Department of Obstetrics and Gynecology, offers that extra care by combining high quality medical services with compassion to help ensure the best possible outcome for higher risk pregnant women and their developing babies.
Specialists trained in maternal fetal medicine compliment the care offered by the primary obstetrician by providing consultation, co-management, ultrasounds and prenatal diagnosis and procedures for a variety of conditions. Conditions may include diabetes, twins, triplets, premature labor, high blood pressure, recurrent pregnancy loss, infectious disease, blood clots, heart disease, kidney and gastrointestinal diseases and other medical disorders complicating pregnancy. There may also be times where specialized procedures are needed with some higher risk pregnancies. These procedures are performed by a team including a board certified physician, highly trained OB/GYN nurses, experienced ultrasound technicians and other caring team members. All collaborate to help ensure a safe and healthy labor and delivery.
Those not experiencing a high risk pregnancy can be comforted by the detailed evaluations of the baby at several points during the pregnancy by Good Samaritan’s experts. Should a situation arise where a physician specializing in maternal fetal medicine is needed, patients have a local option to receive the expert care they may need. Good Samaritan’s Center for Maternal Fetal Medicine’s dedicated staff has the knowledge, training and skill to ensure the safety and wellbeing of both mother and baby during this very special time.
For further information, call the Physician and Health Referral Line at (631) 376-4444.
• Maternal ultrasound
• Fetal MRI
• Fetal ECHO
• Genetc Counseling
• Pediatric Surgical Specialist Consultation
• Counseling regarding short and long term outcome expectations
• Psychological and social support
• Assistance to financial resources
Complications treated include, but are not limited to:
• Abdominal wall defect
• Airway obstruction
• Bladder exstrophy
• Bladder outlet obstruction (posterior urethral valve syndrome)
• Cardiac defects
• Cleft lip and/or palate
• Cloacal deformities
• Congenital diaphragmatic hernia
• Congenital Pulmonary Airway Malformations (CPAM)
• Dandy-Walker malformations
• Esophageal atresia/tracheoesophageal fistula
• Fetal Isoimmunization
• Advanced maternal age (greater than or equal to 35 years of age)
• Pelvic infections, such as chlamydia, gonorrhea, trichimonas, urinary tract infection at time of conception
• Serial ultrasounds to evaluate and detect any bowel problems.
• When the baby is delivered it needs to be done at a hospital that can offer a high level of care.
• The baby can be delivered vaginally. Cesarean sections are recommended only for breech presentation or complications in labor
• Once delivered emergent surgical care is necessary
• Lymphatic malformation (cervical, thoracic)
• Neural tube defects (not amenable to prenatal closure)
• Once seen on ultrasound other physiological defects are looked for. In order to diagnose if there are genetic abnormalities a test called an
amniocentesis can be done.
• When the baby is delivered it needs to be done at a hospital that can offer a high level of care. The baby can be delivered vaginally. Cesarean sections
are recommended if the omphaloceles are very large or they contain the liver.
• Following delivery surgical repair is dependent upon the size of the omphalocele.
• Rh disease
• Sacrococcygeal teratoma (cervical, sacral, or other location)
Below is the detailed description of some of the complications treated at our facility:
Abdominal wall defects
Abdominal wall defect occurs when the baby’s anterior abdominal wall has weakness from not properly forming during development. The abdominal wall weakness allows abdominal organs to protrude through the abdominal wall and develop outside of the abdomen. Thus at delivery the organs that are usually within the abdomen are outside. There are many different types of abdominal wall defects the two most common are gastroschisis and omphaloceles.
Gastroschisis is the extrusion of bowel through a weakening in the abdominal wall usually to the right of the umbilical cord that is not covered unlike an omphalocele. With gastroschisis there is an increased risk of premature (before 37 weeks of gestation) delivery 60% of the time, intrauterine growth restriction in 50%, and stillbirth in 8-10%.
How is Gastroschisis diagnosed?
Seen during the first trimester screening ultrasound or during the anomaly ultrasound done in the second trimester of pregnancy
Management of Gastroschisis
oSerial ultrasounds to evaluate and detect any bowel problems.
oWhen the baby is delivered it needs to be done at a hospital that can offer a high level of care. The baby can be delivered vaginally. Cesarean sections are recommended only for breech presentation or complications in labor
oOnce delivered emergent surgical care is necessary
Omphalocele is a weakness in the central abdominal wall in which the abdominal organs protrude through into the base of the umbilical cord. The abdominal contents are bound within a thin membrane. The contents can consist of just small bowel to small and/or large bowel, liver, spleen, bladder, and stomach. With an omphalocele 50% also have cardiac defects, and 40% of the time have gastrointestinal defects. There is increased rate of premature (before 37weeks) births, stillbirth, and neonatal death due to associated anomalies.
What causes an omphalocele?
In 30-40% of fetuses it is caused by genetic abnormalities. There are syndromes that have omphaloceles: Beckwith-Wiedemann syndrome, Pentalogy of Cantrell, OEIS complex.
How are Omphaloceles diagnosed?
Seen on the anomaly ultrasound conducted in the second trimester
Management of Omphaloceles
oOnce seen on ultrasound other physiological defects are looked for. In order to diagnose if there are genetic abnormalities a test called an amniocentesis can be done.
oWhen the baby is delivered it needs to be done at a hospital that can offer a high level of care. The baby can be delivered vaginally. Cesarean sections are recommended if the omphaloceles are very large or they contain the liver.
oFollowing delivery surgical repair is dependent upon the size of the omphalocele.
Clubfoot is an abnormal shortening of the muscles and tendons in your baby’s foot, causing the baby’s foot to be twisted at a sharp angle to the ankle, somewhat resembling a golf club. It can be mild or severe, and is usually not associated with any other problems in your newborn. Half of the babies who have clubfoot have it in both feet. If it is not corrected, it will make it hard for your baby to walk.
How is clubfoot diagnosed?
Clubfoot can be seen on ultrasound. Sometimes, due to the position of your baby in the ultrasounds, it is not seen before the baby is born. It is very easy to diagnose at birth, if it is not seen on an ultrasound before the baby is born. Occasionally, after the baby is born, he or she will need x-rays of his or her feet. If it is seen on an ultrasound, you will probably be put in contact with an orthopedic surgeon (bone doctor), and maybe a genetic counselor, if your doctor thinks it might be part of a syndrome.
How do we fix club foot?
Because babies are so flexible, treatment for clubfoot usually starts within 1-2 weeks after the baby’s birth, so that the baby’s foot can be put back in the right position before he or she starts to walk. The most common treatment for clubfoot is stretching and casting, also known as the Ponseti Method. To do this, the baby will have his or her foot moved into the correct position, and then put into a cast. This cast will probably be replaced once or twice per week. After the casting, your baby may require surgery to lengthen his or her Achilles tendon.
After the foot is back in position, you may need to do stretching exercises with your baby, and he or she may need to wear special braces or shoes. If this method does not work, there are other techniques that can be used, and if none of the traditional methods work, surgical correction is an option. In the majority of cases, your baby will most likely go on to walk and run normally, and wear normal shoes.
Rh disease is a problem between your blood type and your baby’s blood type, when an Rh negative mother and a Rh positive father have an Rh positive baby. Sometimes, during pregnancy, your baby’s blood is able to enter your bloodstream. In an Rh negative mother, the baby’s blood causes a reaction where the mother makes antibodies against her baby’s blood. These antibodies are able to get through the placenta and can destroy the baby’s blood. This is bad for your baby, and in the worst cases, can lead to your baby’s death. This will not happen in your first pregnancy, but it can happen in your next pregnancies.
How do we test for Rh disease?
At the beginning of your pregnancy, your doctor will do a blood test on you to see your blood type and whether or not your blood has any antibodies to your baby’s blood. The antibody that your doctor is looking for is called anti-D antibody.
What do I do if I have Rh disease?
If you have Rh disease, your baby will have a special kind of ultrasound test called middle cerebral artery Doppler monitoring. It is a test where we measure the speed of the blood moving through an artery in your baby’s brain. It is not an invasive test, and it will probably be done every week. The antibody levels in your blood may also be tested. If we find that your baby does have severe anemia, he or she may need a blood transfusion before birth. After the baby is born, he or she may need to be monitored more closely for jaundice, and may require blood transfusions after he or she is born as well.
How do I prevent Rh disease?
If you have Rh negative blood, you will receive an injection of RhoGAM at 28 weeks of gestation. After you deliver, they will test your baby’s blood type, and if he or she is Rh positive, you will get another dose of RhoGAM. If he or she is Rh negative, you will not get anymore RhoGAM.
Shared Decision Making is the collaboration between patients and caregivers to come to an agreement about a health care decision. The service greatly assists patients in making difficult decisions and aims to provide information in a basic fashion so that patients may understand the condition. Patients will have the opportunity to discuss the particular condition, treatments that may be available, and outcomes based on those treatments. Decisions can be difficult as there is often more than one choice that can be made, and there may be no “correct” choice. The choices that are made are based on what is important to each individual.