Patient Care Services

High-risk Pregnancy/Perinatology Services
If a woman experienced complications during a previous pregnancy or is considered high risk because of existing medical conditions or family or personal history, she may wish to consult with Greenwich Hospital's Perinatology Services or the hospital's genetic counselors before becoming pregnant.

What is Perinatology?
For a number of reasons, some women need to be watched more closely during pregnancy. Perinatology, also called Maternal Fetal Medicine, is the field of obstetrics devoted to managing those high-risk pregnancies. Women may be at increased risk for complications if they have high blood pressure, diabetes, lupus or another medical condition that would be affected by pregnancy or that may affect the pregnancy. Pregnancy-related problems, such as expecting two or more babies, premature labor, or a concern about the developing fetus may indicate a consultation with a perinatologist.

Referral to a Perinatologist
The vast majority of women are referred to perinatologists by their obstetricians or infertility specialists. Women may be referred in early pregnancy because they have a medical condition that puts them at risk for complications, such as a history of premature delivery or pregnancy loss. Or, they may be seen for help with conditions such as preeclampsia that occasionally develop later in pregnancy. Some women see a perinatologist even before they become pregnant. Some patients refer themselves to the Perinatology Service at Greenwich Hospital.

Appointments
To make an appointment or for more information about Perinatology Services at Greenwich Hospital, please call (203) 863-3674.

The Obstetrician's Role
Though a woman may see a perinatologist several times during a pregnancy, her own obstetrician will continue to manage the pregnancy and will deliver the baby. The perinatologist works closely with a woman's obstetrician to develop a care management plan tailored to the patient's individual needs and history. The perinatologist is usually not present at the birth of the baby, but may consult with a neonatologist (who specializes in premature babies) before the delivery to make sure all necessary services are in place.

Comprehensive Services
As part of the Department of Women and Children's Services, Greenwich Hospital's Perinatology Service offers maternal and fetal medical management, monitoring, ultrasound, genetic counseling, diabetes education, and more. Perinatologists make sure women understand how an illness may affect their pregnancy and how a pregnancy may affect an underlying maternal condition.

Diabetes Education
This program offers education about diabetes and the importance of nutrition in developing a diet and insulin regimen. The perinatologist usually manages any required insulin adjustments and medical tests, and makes recommendations on the timing of those tests and the optimal time of delivery. In addition, a perinatal nurse educator with specialized training in diabetes is available to help. She can also coordinate meetings with a nutritionist.

Genetic Counseling
Genetic counseling can help individuals and families know the chance of having future children with a given condition. It can help them learn about current research, testing procedures and prenatal testing options pertaining to their age, ethnic background or family history. Counseling also allows couples to make informed decisions regarding amniocentesis.

State-of-the-Art Diagnostic Tests

• Blood Tests: Various blood tests are now available that may aid in the management of women who have had poor pregnancy outcomes. Many of these tests should be performed prior to planning a subsequent pregnancy.
• Ultrasound: Level II ultrasound performed by a perinatologist provides highly detailed images of the developing fetus. The perinatologist can assess development, identify organs and check for problems throughout the pregnancy. Frequency of ultrasound exams is individualized for each patient.

Tests of Fetal Well-Being
To make sure the developing baby is doing well, it is sometimes necessary to perform one or more of these tests.

• Non-Stress Test: This safe, painless test monitors the movements of the fetus and changes in the fetal heart rate in response to its own movements. This test is commonly performed after a woman passes her due date and may be used at other times during pregnancy. Contractions are recorded on a paper strip along with the baby's heart rate. The test normally takes about 20 to 60 minutes.
• Biophysical Profile (In Utero APGAR Score): This assessment is made by measuring fetal movement, tone, breathing activity and level of amniotic fluid with ultrasound imaging.
• Umbilical Doppler Vascular: This test measures the flow of blood through the umbilical cord as a way of assessing placental function. An abnormal Doppler test may be a marker of fetal growth problems.
• Trisomy Screening: A blood test is commonly obtained in the second trimester to screen for Downs syndrome, Trisomy 18 and neural tube defects. Screening for Downs syndrome is also available in the first trimester. A combination of ultrasound and first trimester blood testing has been shown to detect approximately 90 percent of Downs syndrome cases.

Philosophy of Care
Sometimes not knowing what comes next is the hardest part of any uncertain situation. That's why all of the healthcare professionals involved in maternity and perinatology care at Greenwich Hospital take the time to answer questions, inform patients of their options, alleviate their fears and help them feel more comfortable knowing what may happen next.

Preparing for Delivery
As the due date approaches, the perinatologist remains in close contact with the obstetrician who will deliver the baby. This good communication ensures all necessary steps are taken to prepare for delivery. In addition, Greenwich Hospital's Tender Beginnings program offers a wide variety of childbirth preparation classes.

Neonatal Intensive Care Unit
It's reassuring for parents-to-be to know that Greenwich Hospital offers a neonatal intensive care unit for ill and premature newborns.

Resource for Physicians
The Perinatology Service at Greenwich Hospital welcomes questions and inquiries from obstetricians and infertility specialists in the region.