Perinatology

Perinatology is a subspecialty of Obstetrics and Gynecology that studies the health of the expectant mother and fetus from the pre-pregnancy period to the first four weeks after birth, dealing with the diagnosis and treatment of high-risk conditions and also referred to as Maternal-Fetal Medicine.

What is Perinatology?

Perinatology is a medical specialty that focuses on the health of both mother and fetus during pregnancies classified as high-risk due to medical, surgical, or genetic reasons. It is derived from the Latin words "peri" (around) and "natus" (birth).

The primary goal of the perinatology department is to identify potential complications during pregnancy, screen for genetic anomalies, and manage and complete the birthing process in the healthiest way possible, maximizing the quality of life for both mother and baby. It offers a vital monitoring system, especially for expectant mothers with chronic illnesses or for fetuses diagnosed with developmental problems during pregnancy.

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What does a Perinatologist do?

Perinatologists (specialists in Maternal-Fetal Medicine) are physicians who have completed three years of subspecialty training on top of their Obstetrics and Gynecology residency. Unlike a gynecologist, a nanny works to diagnose and monitor more complex pregnancy-related issues; she ensures the safety of both patients (mother and baby) by closely monitoring the baby's development month by month while also tracking the mother's physiological changes.

The duties of a perinatologist include the following:

• Detailed ultrasonography (anomaly screening): Between weeks 18 and 23 of pregnancy, the doctor examines all of the baby's organ systems in detail.
• Identifying risks: The impact of the expectant mother's existing medical conditions (epilepsy, kidney failure, etc.) on the pregnancy is being evaluated.
• Invasive diagnostic tests: Procedures such as amniocentesis (taking fluid from the baby) or CVS (taking a tissue sample from the placenta) are performed.
• Fetal Echocardiography: The structural and rhythmic characteristics of the baby's heart are analyzed at an advanced level.
• Treatment planning: If the diagnosed problem can be treated while the baby is in the womb, surgical or medical intervention may be performed.
• Determining the method and strategy of childbirth: In high-risk situations, the timing and method of delivery (normal delivery or cesarean section) are decided upon.

Why should you visit the Perinatology Department?

You don't necessarily need to have a problem to go to the perinatology department. If the expectant mother has certain risk factors, the patient is referred to the Perinatology department via the Obstetrics and Gynecology department. The expectant mother's age, medical history, or complications in previous pregnancies may indicate the need for perinatological follow-up.

The main reasons why an expectant mother should consult the Perinatology department are as follows:

• Advanced maternal age (pregnancy at age 35 and over)
• History of stillbirth, miscarriage, or premature birth in previous pregnancies
• Chronic illnesses in the expectant mother (hypertension, type 1 diabetes, type 2 diabetes, thyroid disorders)
• Presence of a known genetic disease or chromosomal disorder in the family
• Multiple pregnancy (twins, triplets, or more fetuses)
• Suspicious findings or developmental delay detected during standard ultrasound examinations
• Consanguineous marriages and the associated increased genetic risks.
• Investigating the effects of infections or medications used during pregnancy.

What diseases does the Perinatology Department treat?

The perinatology department is a comprehensive medical unit that deals with both maternal and fetal diseases. Perinatology focuses on pathological conditions triggered by or aggravated by pregnancy. The focus is on systemic problems on the mother's side and structural developmental disorders and genetic syndromes on the baby's side.

The diseases treated by the perinatology department are as follows:

• Preeclampsia and Eclampsia: High blood pressure and protein leakage, known as preeclampsia, are among the issues addressed.
• Gestational diabetes: Gestational diabetes is controlled and insulin administration is managed.
• Placental anomalies: This includes anomalies such as placenta previa (placenta located in front) or placenta accreta (placenta attached to the uterine wall).
• Fetal Growth Restriction (IUGR): If the baby does not gain enough weight and receive sufficient nutrition in the womb, it poses a risk.
• Cervical insufficiency: This includes the risk of premature birth due to cervical insufficiency and the necessary surgical procedures.
• Blood (Rh) incompatibility: It focuses on fetal anemia and hydrops (accumulation of fluid in the baby) problems that develop due to blood incompatibility.
• Congenital anomalies: Structural abnormalities in the baby's organs (heart, kidneys, brain, spine) are evaluated and managed.
• Chromosomal disorders: Conditions such as Down Syndrome (Trisomy 21) and Edwards Syndrome (Trisomy 18) are detected.

What diagnostic tests are performed in the Perinatology Department?

Perinatological diagnostic methods are divided into two categories: invasive (interventional) and non-invasive (non-interventional). Although technological advancements have made it common to screen mothers' blood samples without harming the baby, invasive methods may still be necessary for a definitive diagnosis.

The following diagnostic and screening tests can be performed in the Perinatology department:

• Detailed ultrasonography: Between weeks 18 and 24, all organs are examined in 2D, 3D, or 4D.
• NIPT (Non-invasive Prenatal Test): Chromosomal screening is performed by analyzing free fetal DNA in the mother's blood.
• Amniocentesis: It is the process of taking a sample of the fluid surrounding the baby using a thin needle.
• Chorionic Villus Biopsy (CVS): It is the process of taking a tissue sample from the placenta in the early stages of pregnancy.
• Cordocentesis: This is an analysis performed by taking a blood sample from the baby's umbilical cord.
• Fetal Echocardiography: This is a detailed ultrasound examination of the baby's heart cavities and heart valves.
• Doppler Ultrasonography: It allows monitoring the baby's nutritional status by measuring blood flow rate.

What are the types of high-risk pregnancies?

A high-risk pregnancy occurs due to problems that could threaten the health of the mother or the baby. The most common types of high-risk pregnancies are as follows:

• Maternal-related high-risk pregnancy: It is caused by uncontrolled diabetes, chronic hypertension, kidney diseases, autoimmune diseases (Lupus, etc.), obesity or extreme weakness.
• Risks associated with pregnancy: Pregnancy poisoning (preeclampsia) is caused by problems such as gestational diabetes, short cervix, and premature rupture of membranes (early water breaking).
• High-risk pregnancy due to fetal reasons: Multiple pregnancies can result from problems such as structural anomalies in the baby, fetal growth restriction, and hydrops due to blood incompatibility.
• High-risk pregnancy due to placental reasons: It occurs due to abnormal placental placement, such as the placenta covering the cervix or being attached too deeply to the uterine wall.
• History-based high-risk pregnancy: This can result from a history of recurrent miscarriages, stillbirths, or premature births in previous pregnancies.

What is the difference between a gynecologist and a perinatologist?

A gynecologist specializes in women's reproductive health and the monitoring of normal pregnancies. A perinatologist is a specialist physician who has further developed training in the field of high-risk pregnancies.

Can a perinatologist be present at a birth?

Perinatologists are actively involved in the birthing process, especially for high-risk pregnancies. Perinatologists may not routinely attend every birth, but if the birth presents a risk or the baby needs immediate intervention after birth, a perinatologist can manage the entire birth process from start to finish.

A perinatologist is present at the time of birth or can fully manage the birth in the following situations:

• If excessive bleeding is expected during childbirth
• If there is placenta previa or a spectrum of placenta accreta
• If the birth is going to happen very early in the week (premature)
• If the baby has an anomaly requiring intervention at birth
• If there is a triplet, quadruplet or more multiple pregnancy

What week of pregnancy should you be in to visit the Perinatology Department?

Detailed ultrasounds are generally preferred between weeks 18-23, but a visit to a perinatologist can also be made between weeks 11-14 to assess genetic risks.

If the Double Screening Test comes back clear, is there any need to see a perinatologist?

Yes, because screening tests only measure chromosomal risks, but a perinatologist examines structural abnormalities in the baby's heart or other organs.