Perinatology

Even before getting pregnant, some conditions can raise the likelihood of a high-risk pregnancy. We offer services to women who are considering becoming pregnant to help reduce and manage their risk.

• Preconception consultation — Our MFM specialists consult with women prior to conception to discuss concerns and offer recommendations.
• Management and prevention of preterm birth — If you have had a preterm birth in the past, we offer specialized planning to help you carry your next child to full term. Also called a premature baby or preemie, a preterm birth is when the baby is born more than three weeks early. 
• Recurrent pregnancy loss — We understand that having multiple miscarriages can be discouraging, and we offer compassionate care to help you have a successful pregnancy. 

Maternal-fetal medicine specialists may order a range of prenatal screening tests and diagnostic exams. The type of maternal fetal testing performed depends on several factors, including the mother’s age, health history, genetic profile and risk factors. 

• Genetic counseling/carrier screening — Blood, saliva or tissue from the inside of your cheek is tested to see if you carry the genes for certain disorders, including cystic fibrosis, fragile X syndrome, sickle cell disease and Tay–Sachs disease. Carrier screening can reveal your risk of having a child with a genetic disorder. 
• Nuchal translucency screening — This special ultrasound helps assess the risk of Down syndrome. It measures the size of the fluid-filled space in the tissue at the back of a baby’s neck, known as the nuchal translucency. 
• Detailed fetal imaging/ultrasound — Ultrasound exams use sound waves to create images of the embryo or fetus on a monitor. The tests help evaluate a baby’s physical development, screen for major abnormalities and estimate how far along your pregnancy is. There are several types of obstetric ultrasound exams:
• 2D ultrasound produces flat two-dimensional images and is the standard type of fetal ultrasound
• 3D ultrasound creates three-dimensional images and may be used to detect certain birth defects that are not visible in 2D
• 4D ultrasound creates a live video effect and is rarely used for clinical evaluations  
• Amniocentesis — Using a needle carefully inserted into the abdomen, the physician removes a sample of the fluid around the fetus (called amniotic fluid) to be tested for chromosome abnormalities and other conditions.
• Chorionic villus sampling (CVS) — Using a needle carefully inserted into the abdomen or a catheter inserted through the cervix, a sample of tissue is removed from the placenta and tested for abnormalities.
• Combined first trimester nuchal translucency screening — This test combines the results of a blood test and special ultrasound (called nuchal translucency screening) to help determine a baby’s risk of having Down syndrome or other chromosome abnormality . 
• Fetal echocardiogram — If your baby has an increased risk of congenital heart disease, you may have a fetal echocardiogram to evaluate the baby’s heart. This test is performed using abdominal ultrasound (over the belly) or transvaginal ultrasound (through the vagina).  
• Cordocentesis — Also known as percutaneous umbilical blood sampling, cordocentesis removes a sample of the fetus’s blood from the umbilical cord and tests it for blood disorders, chromosome disorders or infections. 
• Fetal blood sampling — This test removes a sample of the fetus’s blood from the umbilical cord or from a blood vessel in the liver or heart. The test looks for blood disorders, chromosome disorders or infections. 

Antepartum refers to the period before you give birth, usually beginning around the 26th week of pregnancy. During this time, your perinatologist may recommend the following fetal assessments.

• Biophysical profile (BPP) — The BPP evaluates your baby’s health during pregnancy to determine how well your baby is developing. It measures heart rate, muscle tone, movement, breathing and the amount of amniotic fluid around your baby. 
• Fetal nonstress test (NST) — This common test evaluates the baby’s heart beat through a monitor placed on your belly.
• Doppler studies — Fetal Doppler ultrasound tests are performed to assess blood flow to the uterus or blood flow in the fetus. 

Scripps perinatology specialists are experts in managing a full range of pregnancy complications. Our goal is to reduce the risk of complications with high-risk pregnancies. Depending on your specific needs, your treatment plan may include:

• Cervical insufficiency management and cerclage — Weak cervical tissue may cause the cervix to soften or dilate too early in pregnancy, raising the risk for miscarriage or premature birth. Treatment may include more frequent ultrasounds to monitor the condition, progesterone injections or a procedure to close the cervix until it is time to deliver your baby. This procedure is known as cerclage or cervical stitch.
• Gestational hypertension, preeclampsia, eclampsia and HELLP management
• Gestational hypertension is high blood pressure that develops during pregnancy.
• Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems, most often the liver and kidneys. It usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.
• Eclampsia is preeclampsia with seizures. It can occur if preeclampsia isn’t controlled. This is a serious condition and may lead to immediate delivery.
• HELLP syndrome is a more severe type of preeclampsia. It’s an acronym that stands for hemolysis (red blood cell destruction), elevated liver enzymes and low platelet count. Delivery is the recommended treatment.
• Placenta disorders management — The placenta attaches to the wall of the uterus during pregnancy and provides oxygen and nutrition as the baby grows. Typically, the placenta detaches at childbirth and is delivered after the baby. If there are problems with the placenta, the following conditions may develop:
• Placenta previa is when the placenta covers all or part of the cervix, which is the opening of the birth canal. If it occurs late in pregnancy, the baby may need to be delivered by cesarean section (c-section). Some women may also have vasa previa, which is when the fetus’s umbilical cord blood vessels grow across the cervix.
• Placenta accrete spectrum is when the placenta grows too deeply into the uterine wall. This can cause serious bleeding after delivery because the placenta does not detach properly. Depending on how deeply it's grown, it is sometimes called placenta increta or placenta percreta. When diagnosed during a pregnancy, a team of specialists needs to manage the labor and delivery process, and a hysterectomy may be recommended.
• Vasa previa is when the fetal blood vessels are crossing over or are close to the opening of the cervix 
• Premature rupture of membranes (PROM) management — Premature rupture of membranes is when a woman’s water breaks too early, before labor has started. Depending on how far along the pregnancy is, treatment may include careful monitoring, medication to treat infection or help the baby’s lungs develop, or early delivery.
• Preterm labor management and prevention — Preterm labor is when the body goes into labor between week 20 and week 37 of pregnancy. Treatment may include taking steps to stop the labor, including bed rest and medication, and could lead to hospitalization.
• Management of fetal complications — Perinatologists monitor and manage complications that may put the health and safety of the fetus at risk, including: 
• Alloimmunization (antibodies that attack fetal red blood cells)
• Fetal growth restriction 
• Infections
• Multiple gestations (for example, twins or triplets)
• Nonimmune hydrops (swelling and excessive fluid in the heart, lungs and abdomen)
• Management of preexisting maternal conditions — Maternal-fetal medicine doctors also work with other specialists to monitor and manage preexisting maternal conditions that may be affected by pregnancy, such as:
• Blood conditions
• Bone, cartilage and skin disorders 
• Brain conditions
• Cancer
• Diabetes
• Digestive and gastrointestinal (GI) disorders
• Heart disease
• Infections and autoimmune disorders
• Kidney problems 
• Lung problems
• Obesity
• Respiratory problems 
• Thyroid and endocrine disorders

When women with high-risk pregnancies need care that is not available at their hospital, our Maternal Transport Program helps ensure that they are safely transported to another site that can provide optimal care for mother and baby. Our multidisciplinary approach allows us to care for most women with high-risk pregnancies at Scripps hospitals.

• Gestational diabetes — When a woman develops high blood sugar while she is pregnant, it is called gestational diabetes. It is important to see the right specialist for gestational diabetes to prevent complications during pregnancy and delivery. 
• Type 1 diabetes — Type 1 diabetes is a lifelong disease in which the pancreas produces little to no insulin. Type 1 diabetes is not affected by lifestyle, and people with this type must take insulin. About 5% of people with diabetes have type 1. 
• Type 2 diabetes — Type 2 diabetes is the most common type of diabetes. It occurs when the body doesn’t make enough insulin or can’t use its own insulin effectively. This causes glucose to build up in the blood. Type 2 diabetes is often caused by lifestyle factors, such as obesity or diet. 

The nationally recognized Scripps Whittier Diabetes Institute collaborates with the perinatology team to help you manage your blood sugar during pregnancy and help ensure a safe delivery. For more information call 858-956-7719.

If you or your baby has a heart condition, it is important to have access to expert cardiac care. Cardiovascular disease (CVD) is the leading cause of maternal deaths in the United States and California, and most of these women did not have symptoms of heart disease before becoming pregnant. Early diagnosis and treatment of heart disease is important.

Scripps is nationally recognized as a leader in heart care, and our Pregnancy Heart Center is dedicated to delivering comprehensive cardiac care for women and their children before, during and after pregnancy through a multidisciplinary, team-based approach.  

Our perinatologists work closely with cardiology specialists to care for heart conditions in both mother and baby. The cardiologists are experts in both cardiology and integrative/holistic medicine and provide specialized care for pregnant women with heart conditions. The Pregnancy Heart Center also has a fetal cardiologist and MFM-trained sonographer on staff who are board certified in fetal echocardiography.  

To ensure you receive the best care, our perinatology team may work with the following departments to ensure you and your baby receive an optimal outcome and support. Our Maternal Team includes but is not limited to the following:

• Adult cardiology
• Adult CT surgery
• Critical care
• Obstetrical anesthesia
• Interventional cardiology
• Radiology/cardiac imaging
• Patient navigator
• Pharmacist
• Registered dietitian/nutritionist
• Mental health 

Our Fetal Team includes:

• Pediatric cardiology
• Pediatric CT surgery
• Neonatology
• Prenatal genetic counseling
• OB-GYN
• Registered dietitian/nutritionist
• Patient navigator
• Non-profit/community alliances

In addition, our staff is involved in research, education, disease prevention and innovation to achieve the best possible outcomes. Our Neonatal Team collaborates with leading cardiac centers across the state including:

• Loma Linda University
• Children’s Hospital Los Angeles
• UCLA
• Rady Children’s Hospital 
• Stanford

Genetic counselors have advanced education and training in medical genetics and counseling. They meet with women who are pregnant or planning to become pregnant to advise them about genetic disorders that may affect their pregnancy or be passed on to their baby.

• Education — Counselors can explain genetic disorders and the genetic testing process.
• Guidance — Counselors can help women decide if they should have genetic testing and guide them through the testing process.
• Interpretation of test results — After testing, counselors explain the results and what they mean, and advise patients about their options. 
• Support — Counselors offer compassionate support, advice and resources to families affected by genetic disorders.

Perinatologists collaborate with your care team (for example obstetricians, other specialists and neonatologist) to establish a plan for delivery to help mother and baby have successful, healthy outcomes. 

Plan ahead for your hospital stay, from deciding what to bring with you to making sure you have other needs such as childcare and pet care covered while you’re in the hospital. Find more information about what to expect.

• What to pack for your hospital stay
• Scripps birthing locations
• Delivering your baby at Scripps Memorial Hospital Encinitas
• Delivering your baby at Scripps Memorial Hospital La Jolla
• Delivering your baby at Scripps Mercy Hospital

Scripps offers classes, support groups and other resources for women before, during and after pregnancy. If you’re pregnant, planning to have a baby or recently gave birth and need breastfeeding or postpartum support, check out our programs and classes.  

• Childbirth and parenting classes
• Breastfeeding support groups and classes
• Prenatal and parenting programs and resources

All babies need care after birth, but some require more specialized care. Scripps Health and Rady Children's Hospital offer four levels of specialized care for infants that need it.

Yes. These specialists work closely with each other, and most women who see a perinatologist will continue to see their obstetrician. In certain cases, your care may be transferred to the perinatologist entirely, but this is not common.

If your genetic counselor recommends testing and you decide to have it, your results will generally be available within one to three weeks after the test date.

The most appropriate type of ultrasound for you will depend on your specific concerns. You are welcome to ask the sonographer any imaging questions you may have.

The Scripps perinatology department is open from 7 am to 5 pm. Patients are scheduled from 7 am to 3:30 pm.