Maternal-fetal specialists help ease worry of high-risk pregnancies

Expectant mothers are filled with excitement and joy at the prospect of welcoming a new member to the family. Nurseries are prepared and baby showers are planned with the expectation that the pregnancy will go smoothly. But what should you expect if your pregnancy isn’t what you are expecting?

Turning to the experts at the Institute for Maternal-Fetal Medicine at Sinai Hospital of Baltimore can ease a mother’s mind.

A high-risk pregnancy is one in which some condition puts the mother, the developing fetus, or both at higher-than-normal risk for complications during or after the pregnancy and birth.

Certain factors can limit the likelihood of having a healthy, full-term pregnancy. These include the mother’s age; medical conditions such as high blood pressure, obesity and a history of infertility; and whether there is more than one embryo.

The goal is to keep these bundles of joy from arriving in the world too early. The No. 1 reason babies die is prematurity, says Pedro P. Arrabal, M.D., the director of Sinai’s Institute for Maternal-Fetal Medicine (click here to see photos). Maternal-fetal obstetricians like Arrabal specialize in high-risk pregnancies.

“One of our major roles is knowing when to deliver,” Arrabal says. “We are aggressive in trying to stop premature labor. Our job is to make sure pregnancy can safely be continued for mother and fetus.”

Nationwide, there are 1,400 obstetricians who subspecialize in maternal-fetal medicine. And three of them are at Sinai. Most high-risk pregnancies are co-managed with the mother’s regular obstetrician.

With proper guidance and prenatal care, risks can be minimized. While age is a common risk factor, Arrabal delivered a healthy baby for a 51-year-old mother, and has successfully delivered babies for many women in their late 40s.

“We are seeing more and more older moms,” he says.

As diabetes rates sore, Arrabal has also seen more diabetic patients. There is an American Diabetes Association–accredited obstetric program at Sinai and a diabetes educator whose sole responsibility is working with pregnant women.

“Some community hospitals can’t handle these complicated cases,” Arrabal says. “We have an excellent NICU (Neonatal Intensive Care Unit), major medical subspecialties and pediatric subspecialties. We have extensive support for mom and baby.”

Jacqueline Eldridge Wheeler, R.N., is the patient care manager of Labor and Delivery at the BirthPlace at Sinai. She says the nursing staff prepares extensively for high-risk pregnancies. There are meetings, often involving the mother, and the teams at Sinai emphasize communication.

“The nurses are constantly educating themselves,” Eldridge Wheeler says. “And we’re communicating with our mothers so that they know what to expect and they feel comfortable knowing that we’re experienced with high-risk pregnancies.”

Plus, the sophisticated machines and technology available at the BirthPlace at Sinai make it easier to handle complications.

“We are able to react immediately if we’re not already there at the bedside,” she says. “We can handle multiples or pregnancies with complications in order to make labor and delivery go as smoothly as possible.”

Arrabal, who also speaks Spanish, encourages patients to ask questions throughout their pregnancy, providing his e-mail and business card to expectant mothers. “There’s a lot of bad information on the Internet. I tell my patients to contact me with questions or concerns.”

The institute also provides preconception counseling. Genetic counselors are available to discuss testing to see whether the parents are carriers of disorders such as cystic fibrosis and Tay-Sachs disease. The institute, located at the Louis and Henrietta Blaustein Women's Health Center at Sinai, also offers the latest in tests to determine whether the baby is healthy or has potential birth defects.

“We want to give an early developing embryo the best environment possible,” Arrabal says.

Eldridge Wheeler says she’s also proud of Sinai’s programs specifically developed to interact with women following the delivery of their baby. This includes screenings for postpartum depression.

“Having a healthy baby is just the beginning,” she says.

For more information about the Institute for Maternal-Fetal Medicine, call 410-601-WELL (9355).