The Medical City - High Risk Pregnancy Subspecialty Care (Maternal-Fetal Medicine)

PATIENT SERVICES

High Risk Pregnancy Subspecialty Care (Maternal-Fetal Medicine)

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IWH provides the highest level of specialized care, counseling, and diagnostic services for women with high-risk pregnancy with our board-certified maternal-fetal medicine (MFM) subspecialists. IWH offers comprehensive screening for preeclampsia at any trimester during pregnancy. Preeclampsia is one of the most common complications affecting pregnant women in the Philippines. IWH also provides advanced antenatal fetal surveillance tests for women with high-risk pregnancy to ensure fetal well-being. For women requiring inpatient monitoring of their condition, IWH offers the Maternal Intensive Care Unit that provides intensive one-on-one monitoring for both mother and baby. Our MFM subspecialists work in collaboration with a team of subspecialists in Obstetric Anesthesia, Neonatology, Internal Medicine and other fields.

IWH provides the highest level of specialized care, counseling, and diagnostic services for women with high-risk pregnancy with our board-certified maternal-fetal medicine (MFM) subspecialists, also called Perinatologists. Perinatologists have advanced knowledge of the obstetrical, medical, genetic and surgical complications of pregnancy and their effects on both the mother, the fetus, and the family. As a result, they are able to take care of pregnant women who have special medical, surgical or gynecologic problems (e.g. heart or kidney disease, hypertension, diabetes, etc.), pregnant women who are at risk for pregnancy-related complications (e.g. preterm labor, preeclampsia and multifetalpregnancies), and pregnant women with fetuses at risk (e.g. chromosomal or congenital abnormalities, infections, genetic disease, growth restriction). They also handle pre- and post- pregnancy evaluation and management of patients with previous poor pregnancy outcome (e.g. recurrent pregnancy loss, previous babies with anomalies, parental genetic abnormality).

The Medical City has a High-Risk Pregnancy Clinic, situated within the Women’s Health Care Center (WHCC), to address your outpatient consult and diagnostic needs. Here, we offer a comprehensive prenatal screening and diagnostic services that can be used to diagnose health conditions early, including:

  1. Combined screening test for preeclampsia
    This test is ideally done during the first trimester of pregnancy between 11 weeks and 13 6/7 weeks, but may also be done during the second and third trimester. It is a non-invasive test that combines ultrasound studies of blood flow across the uterine arteries, blood pressure (BP) readings and blood tests (serum placental growth factor and serum pregnancy-associated plasma protein A) to determine an individual woman’s predisposition to develop preeclampsia and its complications during pregnancy. Knowing whether a woman is at high risk for preeclampsia will ensure that the appropriate preventive care and monitoring is given to her. by her healthcare providers
  2. Combined first trimester screening test for Down Syndrome, Trisomy 18 and Trisomy 13
    This is a non-invasive test done between 11 weeks and 13 6/7 weeks of pregnancy. It combines a woman’s risk factors with ultrasound measurement of the nuchal translucency with blood tests (Serum pregnancy-associated plasma protein A or PAPP-A, Serum free beta-HCG). Knowing whether a woman is carrying a baby at risk for trisomy will enable early diagnosis and confirmation with invasive diagnostic testing.
  3. Non-invasive prenatal testing
    This is a non-invasive test that can be done as early as 9 weeks of pregnancy. The test involves getting a sample of the mother’s blood and looks for a small fraction of fetal cell-free DNA within the mother’s blood to detect whether a woman is carrying a baby at high risk for trisomy. It has a higher detection rate compared with the first trimester screening test and is also able to detect a baby’s sex.
  4. Invasive prenatal testing
    This confirmatory test is intended for those women with a positive test on either the combined first trimester screening or the non-invasive cell free DNA testing. Guided by an ultrasound, the Perinatologist obtains blood from the umbilical cord of the fetus (cordocentesis), or a sample of amniotic fluid from the uterus (amniocentesis). These specimens contain cells which can provide information regarding your baby’s karyotype, if there are certain genetic conditions, infection, are present in the baby. This procedure is usually performed in the second trimester of pregnancy (starting at about 15 weeks gestation). Women usually undergo genetic counseling before and after having amniocentesis.

We also offer different fetal imaging techniques that can be used to diagnose health conditions early. Oftentimes, using the diagnostic tools can detect potentially fatal birth defects before birth. Our Perinatologists are specially trained to look for fetal abnormalities using advanced imaging techniques, including:

  1. Congenital anomaly scan
    This type of ultrasound exam is a detailed exam of the baby’s organs and features. It is usually done after 18 weeks of pregnancy. It can help explain abnormal screening test results and provide more information. When needed, a 3D/4D and AI-assisted ultrasound assessment may be done to enhance images initially seen on 2D ultrasound. This state of the art ultrasound technology has the advantage of additional depth and detail rendering the resulting image more distinct and comprehensible to the family.
  2. Fetal echocardiography
    • Fetal echocardiography is a specialized ultrasound study that focuses on the fetal heart. We look at the structure and blood flow through the fetal heart and fetal cardiac rhythm. Fetal echocardiograms are noninvasive, similar to an adult 2D-echocardiogram. Our state-of-the-art ultrasound machine has the advantage of better fetal heart imaging using 3D/4D. Coordination of appointments with a pediatric cardiologist is provided for those patients requiring additional cardiology service in order to offer the very best in prenatal care to a mother and her unborn child.
    • Indications for fetal echocardiography include, but are not limited to:
      • Previous child born with a congenital heart defect
      • Other family history of heart problems
      • Fetal arrhythmia (abnormal cardiac rhythm)
      • Fetus with a chromosomal abnormality
      • Fetus with suspected cardiac abnormality
      • Fetus with other congenital anomalies
      • Maternal lupus and/or Connective Tissue Diseases
      • Medication or teratogen exposure

Detecting health conditions early give our doctors the knowledge whether the birth defect can be managed with medical therapy during pregnancy or immediately after birth with surgery. In those cases of birth defects amenable to treatment during pregnancy or right after birth, our Fetal Care Team is available and composed of board-certified maternal fetal medicine subspecialists, neonatologists, pediatric cardiologist, pediatric surgeons and other specialists. Below are some of the fetal therapy procedures our Maternal-Fetal Medicine specialists perform:

  1. Amnioreduction
  2. Amnioinfusion
  3. Cordocentesis (fetal blood sampling)
  4. Intrauterine transfusion
  5. Management of fetal dysrhythmia
  6. Ex-utero intrapartum treatment and delivery

The high-risk mother and baby can be monitored using various fetal surveillance tests to ensure good fetal well-being. This includes:

  1. Fetal biometric studies for growth monitoring
  2. Obstetric Doppler studies
  3. Biophysical profile score
  4. Nonstress test and contractions stress test

For women requiring inpatient monitoring of their condition, IWH offers the Maternal Intensive Care Unit that provides intensive one-on-one monitoring for both mother and baby. This is a specialized unit housed within the Labor and Delivery Suite Complex that is fully equipped with medical intensive care facilities, and designed to fit the high-risk pregnant woman’s special needs, with centralized electronic fetal monitors and a dedicated ultrasound machine. Our MFM subspecialists work in collaboration with a team of subspecialists in Obstetric Anesthesia, Neonatology, Internal Medicine and other fields. To complement our Maternal ICU in receiving high-risk newborns, is our state-of-the-art Neonatal Intensive Care Unit (NICU), with its competent Neonatologists, staff and collaborative specialists (Pediatric Cardiologist, Nephrologist, Neurologist, etc.).