Our Services 2019-01-16T19:44:42+00:00

Medical Services

We offer pre-pregnancy consultation, comprehensive fetal ultrasound, genetic testing, amniocentesis and chorionic villus sampling, prenatal evaluation, fetal testing, comprehensive diabetes program, multiple gestation program and prematurity evaluation and prevention program.

Our physicians and sonographers are certified in first trimester screening with fetal nuchal translucency measurement. We offer 3D/4D ultrasound whenever indicated. Our office is equipped with state of the art ultrasound machines and the latest monitoring equipment.

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Diagnostic Services

  • Comprehensive Fetal Ultrasound
  • Amniocentesis
  • Chorionic Villus Sampling (CVS)
  • Genetic Counseling and Testing
  • Prenatal Evaluation
  • Fetal Testing
  • Comprehensive Diabetes Program
  • Multiple Gestation Program
  • Prematurity Evaluation and Prevention Program
  • First Trimester Screening
  • Nuchal Translucency Measurement
  • Pre-Pregnancy Consultations

Fetal Diagnostic Center of Orlando specializes in the diagnosis, treatment and management of high-risk pregnancies. We are committed to providing the highest level of expertise through compassion and dedication to excellence.

FAQs

At Fetal Diagnostic Center of Orlando, our dedicated staff is here to make your visit as easy and stress-free as possible. For your convenience, we’ve compiled a list of Frequently Asked Questions (FAQs) we often address from patients. Have a question or concern not addressed here? Please let us know by calling (407) 897-3737 during normal business hours and a member of our staff will be happy to assist you.

Maternal Fetal Medicine (MFM) is a subspecialty of obstetrics and gynecology that focuses on the medical and surgical management of high risk pregnancies, diagnosing and treating complications of pregnancy, preexisting medical conditions of the mother that may be affected by pregnancy, and medical conditions that affect pregnancy or may have an impact on the pregnancy outcome.

A maternal fetal medicine specialist, also known as a perinatologist, is an OB/GYN physician who in addition to the standard four-year residency training in obstetrics and gynecology, has completed a three-year fellowship acquiring advanced knowledge of the obstetrical, medical, genetic, and surgical complications of pregnancy and their effects on the mother and fetus. This specialized training prepares the physician to provide care to pregnant women who have special medical problems (e.g., heart or kidney disease, Lupus or connective tissue disorder, hypertension, diabetes and thrombophilia), pregnant women who are at risk for pregnancy-related complications (e.g., preterm labor, preeclampsia and twin or triplet pregnancies), and pregnant women with a fetus at risk because of chromosomal or congenital abnormalities, maternal disease infections, genetic disorders and growth restriction. Maternal Fetal Medicine Specialists are trained in advanced obstetric ultrasound techniques, invasive prenatal diagnosis using amniocentesis and chorionic villus sampling, advanced techniques of fetal evaluation and treatment with procedures such as targeted fetal assessment using Doppler ultrasound, fetal blood sampling and transfusion, fetoscopy and in utero surgery.

A patient is typically referred for care and consultation for one of two reasons, either when a patient is considering pregnancy and knows that she is at risk, or when she is pregnant and existing factors place her at high risk.

Our physicians and professional staff work closely with your primary obstetrician to develop a comprehensive plan of care to achieve the best outcome for you and your baby. During your visit, you will receive an in-depth consultation with one of our physicians to discuss your pregnancy needs and concerns. If a procedure is necessary, you will be provided a detailed explanation of the benefits, limitations and risks of the procedure, and alternative options available.

You may be considered high risk if your pregnancy is complicated by any of the following:

  • Multiple gestation (twins, triplets or more)
  • Preeclampsia or hypertension
  • Liver or kidney disease
  • Autoimmune disease
  • Diabetes (gestational, Type 1 or Type 2)
  • Thyroid disease
  • Lupus or connective tissue disorder
  • Antiphospholipid syndrome
  • Maternal or fetal infections
  • Fetal growth problems
  • Amniotic fluid abnormality (polyhydramnios or oligohydramnios)
  • Fetal anomaly detected by ultrasound
  • Abnormal genetic screen or carrier screen
  • Advanced maternal age (AMA)
  • Abnormal placentation (previa, accreta, vasa previa)
  • Rh negative sensitization

Your pregnancy may also be considered high risk if you have pre-existing medical conditions or if you or your baby develop complications during your pregnancy. The following conditions, including but not limited to, may make your pregnancy high risk.

Pre-existing Medical Conditions

  • Chronic hypertension
  • Diabetes, thyroid or other endocrine disorders
  • Lupus or other autoimmune disorders
  • Liver disease
  • Kidney disease
  • Cystic Fibrosis
  • Heart disease
  • Thromboembolic disease (deep venous thrombosis or pulmonary embolism)
  • Epilepsy or other neurologic conditions
  • Medications used to treat these and other conditions may increase risk for complications

Surgical History

  • Multiple cesarean sections
  • Prior classical cesarean section
  • Uterine surgery to remove fibroids or septum
  • Cone biopsy or LEEP biopsies
  • Bariatric (weight loss) surgeries
  • Heart surgery
  • Brain/spine surgery

Obstetric history

  • Prior preterm birth
  • Preterm premature rupture of membranes
  • Pregnancy loss/stillbirth
  • Two or more second trimester losses
  • History of cervical incompetence/insufficiency
  • History of DES exposure
  • History of Rh or other blood type antibody sensitization
  • History of preeclampsia
  • History of placental abruption (premature separation of the placenta)
  • History of gestational diabetes requiring medication

Current Pregnancy Complications

  • AMA (35 years or above at delivery)
  • Morbid obesity
  • Fetal growth restriction (small fetus)
  • Fetal anomaly detected by ultrasound
  • Abnormal genetic screen or carrier screen
  • Thick fetal nuchal translucency (NT)
  • Amniotic fluid abnormalities (oligohydramnios or polyhydramnios)
  • Placenta previa/placenta accreta (abnormal placentation)
  • Twins, triplets or higher order multiples
  • Vaginal bleeding (second and third trimester)
  • Preeclampsia/high blood pressure
  • Gestational diabetes

Family History

  • Diabetes
  • Chronic hypertension
  • Congenital heart defect
  • Renal disease
  • Thromboembolism (deep venous thrombosis or pulmonary embolism)
  • Other inherited disorders (Marfans, Ehlers Danlos, etc.)

Lifestyle Choices

  • Smoking
  • Alcohol and/or illegal drugs

Genetic/Family History

  • Down syndrome or other chromosomal abnormality
  • Open neural tube defect (spina bifida)
  • Mental
  • Cystic fibrosis
  • Hemophilia
  • Muscular dystrophy
  • Sickle Cell (African heritage)
  • Thalassemia (Mediterranean or Asian heritage)
  • Tay-Sachs disease (Ashkenazi Jewish heritage)

Healthy lifestyle habits are important in managing your pregnancy, weight gain and to your baby’s health. Appropriate weight gain for you depends on several factors, including your pre-pregnancy weight and body mass index (BMI), your health and the health of your baby. Your overall recommended weight gain should be between 11-40 pounds, depending on your BMI.

Pre-Pregnancy Weight Recommended Weight Gain
BMI less than 18.5 28 to 40 lbs.
BMI 18.5 to 24.9 25 to 35 lbs.
BMI 25 to 30 15 to 25 lbs.
BMI greater than 30 11 to 20 lbs.

ALL women should be offered genetic testing for common chromosomal abnormalities such as Down syndrome (Trisomy 21), Edwards syndrome (Trisomy 18) and Patau syndrome (Trisomy 13) or any other conditions that may run in their families. Genetic testing includes both non-invasive screening tests for women at low risk for genetic complications and invasive diagnostic testing for women at high risk for genetic complications.

Non-Invasive Genetic Testing

Non-invasive genetic screen tests are offered to all OB patients, low risk and high risk, and is performed by drawing maternal blood.  These include first trimester screen with or without NT, second trimester screen, sequential or integrated screen and NIPS (fetal DNA in maternal blood).  These are considered screening tests and are not diagnostic.  Abnormal results should be confirmed by invasive genetic testing (amniocentesis or CVS).

Invasive Genetic Testing

  • Chorionic villus sampling (CVS). Under ultrasound guidance, a sample of the placenta is obtained using a sterile needle or catheter. The sample is sent to the lab for analysis. It is typically done between 10-13 weeks gestation to identify chromosomal abnormalities and other inherited disorders.
  • Amniocentesis. Under ultrasound guidance, a sample of amniotic fluid is obtained using a sterile needle and syringe. The sample is sent to the lab for analysis. It is typically performed between 15-20 weeks gestation but can be performed at later gestational ages if indicated.
  • Cordocentesis (percutaneous umbilical blood sampling). Under ultrasound guidance, a sample of the baby’s umbilical blood is drawn with a sterile needle and syringe to identify fetal anemia or certain genetic disorders.

There are certain tests that are performed to ensure fetal well-being.  These tests would include the following:

  • Non-stress test (NST) An external fetal heart monitor is applied to the mother’s abdomen to detect and record the fetal heart activity on paper.  The fetal heart is evaluated for the baseline, accelerations, variability and decelerations. The mother is also monitored for contractions by a tocometer.
  • Biophysical profile (BPP) A BPP combines the NST with ultrasound evaluation of fetal movements, breathing movements, and flexion or extension of extremities with assessment of the amniotic fluid.  Each component gets a score of 0 or 2, with a maximum score of 10.  A score of 8 or 10 is reassuring.

Fetal weight gain may depend on the gender of the baby, race and other factors.  Between 20 weeks to 36 weeks gestation, measuring the uterine fundal height by clinical examination is frequently used to ensure that fetal size correlates to the gestational age; however, this is not as accurate as estimated fetal weight by ultrasound. Fetal weight can be estimated by measuring the fetal head, abdomen and femur. Standardized growth curves are then used to determine if a baby is growing appropriately for the gestational age.

The average fetal weight at 28 weeks gestation is approximately 2 lbs. 3 oz. (1 kg), at 32 weeks gestation,3 lbs. 12 oz. (1.7 kg), at 36 weeks gestation, 5 lbs. 8 oz. (2.6 kg) and at 40 weeks gestation is 7 lbs. 11 oz. (3.5 kg).  The fetal weight gain is approximately 6 ounces per week from 28 weeks to 32 weeks, then 8 ounces per week until 40 weeks gestation.

Patients with a history of preterm delivery are at-risk for recurrent preterm delivery. Hydroxyprogesterone injections (17-P), also known as alpha-hydroxy, has been shown to decrease the risk of recurrent preterm birth. 17-P injections should start at approximately 16 weeks gestation and continue until 37 weeks. Transvaginal ultrasounds should be performed to evaluate cervical length starting at 14-16 weeks until approximately 23-24 weeks to determine if there is evidence of cervical shortening, which further increases risk for extreme preterm birth. If cervical shortening is identified, a cervical cerclage (a stitch in the cervix to prevent the cervix from opening) or vaginal progesterone may be recommended to help prevent recurrent preterm delivery.

Pre-pregnancy consultation is recommended to determine if you may be at risk for cervical insufficiency.  Transvaginal ultrasounds should be performed to evaluate cervical length starting at 12-16 weeks until approximately 23-24 weeks to determine if there is cervical shortening which can be a sign of cervical insufficiency (incompetence).  If there is evidence of cervical insufficiency, a cerclage may be recommended.

Pre-pregnancy consultation is recommended as having a history of preeclampsia in a prior pregnancy increases risks for recurrence of preeclampsia in future pregnancies. Pre-pregnancy consultation includes evaluation for underlying medical conditions that may increase risk for preeclampsia and may include laboratory tests and assessment of your kidneys with a 24-hour urine collection. Low-dose aspirin starting at approximately 12 weeks gestation has been shown to decrease the risk for recurrent preeclampsia, preterm delivery and low birth weight.

You will need to be watched closely for signs or symptoms of preeclampsia such as elevated blood pressure, severe headache, visual changes, right upper quadrant pain or epigastric pain developing.  Ultrasounds to monitor fetal growth are also recommended as preeclampsia can be associated with poor fetal growth and oligohydramnios.

Pre-pregnancy consultation is recommended to discuss risks, methods for prevention, and detection. Increasing folic acid intake for at least 3 months prior to conception is recommended to decrease the risk for recurrence.  Generally, in addition to your prenatal vitamin, an additional 4 mg of folic acid per day is recommended which has been shown to decrease the risk for recurrence of open neural tube defects.  Some open neural tube defects, such as anencephaly, can be identified as early as 11-12 weeks gestation with the majority of spina bifida being identified by ultrasound at 16-18 weeks gestation. Maternal serum alphafetoprotein (MSAFP) is elevated in more than 90% of cases.

Pre-pregnancy consultation is recommended to ensure that your blood pressure is under good control prior to conception and that you are on medications that are safe for you and your baby during pregnancy.  Some antihypertensive medications such as ACE inhibitors may increase risk for birth defects and should be avoided during pregnancy.  Depending on the duration and severity of hypertension, further evaluation of your heart including EKG (electrical tracing of heart) or echocardiography may be indicated.  Assessment of kidney function, including 24-hour urine collection, is also often recommended. Low-dose aspirin starting at 12 weeks has been shown to help prevent preeclampsia, growth restriction and preterm birth.

Pre-pregnancy consultation is recommended to discuss risks associated with pregnancy and to establish a plan for management prior to, during and after pregnancy.  Your care will be coordinated with your hematologist or primary care physician managing your condition.  If you are taking Coumadin, you will need to stop and switch to injectable heparin or Lovenox as Coumadin is associated with birth defects when used in the first trimester.  Other oral medications for treating blood clots are not recommended during pregnancy.

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