Q: What is a Maternal Fetal Medicine Specialist (MFM) or Perinatologist?
A: According to The Society of Maternal Fetal Medicine, the definition for a Maternal Fetal Specialist, who is also known as a Perinatologist is as follows: "A Maternal Fetal Medicine specialist is an obstetrician/gynecologist who has completed two to three years of additional training and formal education and clinical experience. MFM specialists have advanced knowledge of the obstetrical, medical, genetic, and surgical complications of pregnancy and their affects on both the mother and the fetus."
Q: Can I bring my young children to my office visit?
A: Yes! We actually encourage bringing siblings to ultrasound appointments, as this can be an exciting experience for big brothers and sisters-to-be. However, we ask that there is no eating in the office, voices are kept to a reasonable volume and children are either seated or held by an adult while waiting. This helps maintain as serene and peacful an environment as possible for all.
Q: Who do I call for problems?
A: Please contact your primary doctor for all routine prenatal questions. If you experience a problem related to your high-risk condition, please contact See Baby at 404-223-9306.
Q: What test are typically performed by my primary doctor's office?
A: Routine tests may be requested at your primary doctor's office, including prenatal labs, 3rd trimester labs and Group B Strep. Testing that is specific to high-risk medical conditions may be ordered by our medical staff. We will contact you and your primary doctor with these results.
Q: How often will I be evaluated by SEE BABY?
A: This will depend on your history and the condition for which you are being evaluated. You may have appointments weekly, biweekly or monthly.
Q: Does my insurance cover the care provided by SEE BABY?
A: We accept most health plans. You may be required to pay a co-pay at each visit. Please check with your individual insurance policy for details. Additionally, information our Billing Specialist may be able to provide guidance in this regard.
Q: I would like to be evaluated at SEE BABY!
A: Your primary doctor or care provider will refer you to our practice for an initial consultation or fetal ultrasound examination. If your doctor and our staff (Dr. Bootstaylor or Monica Taylor, PA) determine that you are a candidate for follow-up care or co-management, our office will arrange the necessary follow-up visits, ultrasounds and antenatal testing required for your pregnancy care..
Q:Why do I receive ultrasound images via SMS, email, CD, DVD, etc. at the end of my visit, instead of a printed picture like at other ultrasound facilities?
A: We are doing our part to help the environment by preserving trees! During your visit with us at See Baby, our goal is for you to have a unique and exciting experience with your baby. We pride ourselves on being "Green" and have created a virtually paperless workflow, to include distribution of ultrasound images. You may typically take home a small image after your ultrasounds are completed, but outside of that, you can’t do much else with the picture. Electronic images are easier to share with family and friends (via email, text, CD, etc.) or transfer onto posters, mugs, mouse pads, calendars, etc. -- the possibilities are endless! These options can only be extended to you through use of electronic images.
Q: What is an Amniocentesis and CVS?
Amniocentesis is a procedure used to draw a sample of the amniotic fluid that surrounds the baby in the womb. This fluid contains cells that have been sloughed off of the developingfetus.
Amniocentesis is most often used to detect genetic abnormalities, though the results can also reveal the baby's sex, gauge lung maturity (if done close to term), detect amniotic fluid infections, or diagnose other pregnancy related problems.
Amniocentesis can diagnose or rule out many possible fetal abnormalities. Most often, it's used to spot common genetic defects (such as Down syndrome) and neural tube defects (such as spina bifida). Amniocentesis is usually performed between 16 to 22 weeks gestation, although it can be done as early as 13 - 14 weeks and beyond 22 weeks gestation.
Chorionic villas sampling (CVS), a similar test is sometimes used to detect many of the same abnormalities. Instead of amniotic fluid, CVS examines placental cells, which are genetically identical to the fetus. Since CVS can be done earlier in the pregnancy (~ 11 – 12 weeks), and since results are available within 48 hours, it may be preferable for women who need earlier answers about their baby's health. CVS carries a higher risk of miscarriage than amniocentesis, and may increase the risk of limb deformities if performed too early.
Q: What Are the Risks?
About one woman in every 200-400 women can have a miscarriage as a result of amniocentesis, although recent studies suggest that the rate of miscarriage may be as low as one in 1,000 (0.1%). Amniocentesis done during the first trimester carries a greater risk for miscarriage than amniocentesis done after the 15th week. The risk of miscarriage can be similar to that caused by CVS, which is ~ 1:100. Less than one woman in every 1,000 women develop a uterine infection after amniocentesis.
Q: How Can I Prepare?
Amniocentesis provides diagnostic information about the baby. It not a form of treatment, however can provide information to the mother to make certain decisions about treatment. So before you have the test done, think about how you might use the information it provides. Some birth defects are incompatible with life, others are easily correctable, and still others fall somewhere in between.
Weigh the benefits and risks. If the information provided from either CVS or amniocentesis doesn’t impact on your decision about the pregnancy, the test may add more anxiety than it's worth. On the other hand, knowing your baby has a problem may allow you to prepare better for his or her birth. One study of mothers who continued pregnancies after learning their babies had Down syndrome showed they were much better able to cope than women who discovered at birth that their babies were affected.
If you decide to proceed with the amniocentesis or CVS, there is no specific preparation needed, except to maintain a relaxed & calm disposition leading up to the day of the procedure and thereafter. After either procedure, patients are typically advised to maintain reduced activities and no heavy lifting for 12 – 24 hours. Prolonged bed rest or absence from work is not necessary.
Q: What Will Happen?
First, an ultrasound is done to visualize the position of the fetus and placenta. This allows your doctor to determine the safest place to insert the needle. Guided by ultrasound, the doctor carefully inserts a hollow needle through your abdomen, into the amniotic sac, and draws out about four teaspoons (~20 cc) of amniotic fluid. Your baby quickly replaces any fluid that is lost within 12 - 24 hours. During the course of the procedure the patient can observe her baby’s activity before, during and after for reassurance.
If a local anesthetic is used, you may feel a stinging sensation for a few seconds. You may also feel slight pain or cramping when the doctor inserts the needle and pressure in your lower abdomen when the fluid is withdrawn. Some women report no pain or discomfort, and find the “anticipation” of the procedure the biggest obstacle.
After the fluid is removed, the fetal cells are grown in a laboratory and then analyzed. Your doctor will get the complete results within 7 -10 days. On occasion a rapid preliminary test result can be obtained in ~ 24 -48 hours.
Additionally the level of alpha-fetoprotein in the amniotic fluid is measured, which may confer certain risk if abnormally elevated (e.g. risk of neural tube defect). Since alpha-fetoprotein does not need to be cultured in the lab, these results are available right away -- although a potential problem must be confirmed by subsequent genetic analysis of the amniotic fluid.
Who Should Have Amniocentesis?
Amniocentesis is typically offered only to women at increased risk for bearing a child with birth defects. This includes women who:
- Will be 35 or older when they give birth
- Have a screening test or exam result that indicates a possible birth defect or other problem
- Have had birth defects in previous pregnancies
- Have a family history of genetic disorders
If birth defects run in your family, seek genetic counseling before you have amniocentesis - and if possible, before you get pregnant. You and your partner can have certain blood tests to determine your chances of having a baby with a birth defect. Commonly parental carrier testing for such defects such as Cystic Fibrosis or Sickle Cell anemia may preclude the patient from having an amniocentesis or CVS, pending the results.
Amniocentesis Frequently Asked Questions:
Q: Do normal amniocentesis results mean I will have a healthy baby?
A: A normal amniocentesis shows that your baby’s genetics are normal. But even with a normal pattern of chromosomes, your baby can have other types of birth defects. Minor genetic abnormalities may not be detected. About 1 – 3% of all pregnancies are associated with a structural or genetic abnormality.
Q: Can doctors treat any defects diagnosed by amniocentesis?
A: Scientists have been working on possible cures and treatments for a variety of fetal conditions. Many conditions can be treated after birth, and a few can be corrected while the baby is still in the womb, although this type of surgery is still considered experimental. Knowing about a condition ahead of time allows parents and physicians to prepare for the child's special needs, even if his condition can't be treated. Discovering if your baby has a genetic problem such as Down syndrome provides for you information to actively plan for any challenges with the pregnancy and beyond.
Q: I have a relative with Down syndrome. Should I have an amniocentesis?
A: Down syndrome occurs when the cells of a fertilized egg divide abnormally, creating an extra 21st chromosome. Maternal age -- not family history -- seems to be the most important risk factor. A 20-year-old mother, for example, has a 1/2000 chance of delivering a baby with Down syndrome. For a 45-year-old, the chances are significantly higher, ~ 1/40. Very rarely is Down syndrome is inherited when a father or mother carries an egg or sperm with a defective 21st chromosome. If you think you have an increased risk, discuss the benefit and risk of genetic testing with your doctor or a genetic counselor.
Q: Are there alternatives to amniocentesis?
A: There are a number of screening tests that can help assess your risk of having a baby with a chromosomal problem. These tests are routinely offered to women of all ages. Such tests include ultrasound and maternal serum tests & screenings such as: 1) Non-Invasive Fetal DNA testing (Verifi, MaterniT21, Harmony) 2) First trimester screen (Free beta-HCG, PAPP-A, NT), 3) Second trimester screen (Triple and Quadruple marker). These tests are non-invasive, carry no risk of miscarriage or other problems, and can correctly identify 65 - 85% of chromosomal problems. However, none of these tests can confirm that your baby has a problem.