High Risk Pregnancy And Perinatology

What is Perinatology? Why is Perinatology Important?

Perinatology is a subspecialty of obstetrics concerned with the diagnosis and treatment of the fetus and the determination of complicated and high-risk pregnancies. The purpose of perinatology is to determine the risky conditions in pregnancy period and to plan the necessary treatment. Perinatology is very important for:    

• Recovery of the health of pregnant women and babies,
• Early diagnosis of fetal anomalies,
• Screening of chromosomal anomalies,
• Prevention of abortion and death birth,
• Early diagnosis and prevention of premature birth,
• Diagnosis of possible problems which may occur in multiple pregnancies,
• Follow-up of the pregnancies.

What are the services provided at a Perinatology Center? 

• Ultrasound of early pregnancy, and examination of multiple pregnancies:

This type of ultrasound is performed between the sixth week and the eleventh week of the pregnancy. It is examined that if the pregnancy is intrauterine or extrauterine (ectopic pregnancy), and the ‘’Due Date’’ of the pregnancy can be determined in this procedure. In addition, if available, early anomalies of the pregnancy are determined.

Through the ultrasonography performed in this week, it is determined if the pregnancy is singleton or multiple. In addition, if any examination was not made before, anomalies related to the uterus and ovary can be detected. 

• Nuchal translucency scan between the 11^th and 14^th weeks:

It is a screening test in order to measure the collection of fluid in the range of skin and subcutaneous tissue on the nucha of the fetus, through an ultrasound. Though all babies have some fluid, it should not exceed a certain limit. In case that an increase is observed in the fluid, the possibility of both chromosomal and structural disorders increases.  

• Secondary and advanced ultrasound, and management of risky pregnancy:

Adding the examination of fetal heart in the detailed ultrasound examination, which is known as secondary ultrasound, is called ‘’Advanced Ultrasound’’.

The advanced ultrasound can be performed between the 18^th and 23^rd weeks of the pregnancy. Through this ultrasound; the baby’s whole body including the brain, face, spine, heart, stomach, intestines, kidneys, hands, arms and legs is examined anatomically. At the same time, the location and structure of the placenta, which is an organ attached to the lining of the womb, the amount of baby’s fluid and the fetal growth are also examined. In most cases, the parents, who think that their babies develop normally, can feel comfortable. However, a possible anomaly, which may be rarely observed in the baby, can be detected, and all the necessary procedures can be performed without delay. 

• Three-and four-dimensional ultrasound:

Through this ultrasonography, it is possible to see your baby’s three-dimensional picture and ultrasound image at the moment when the ultrasound is performed. It is a very exciting technology for the parents. In the studies made up to now, any harmful effect of 2-3-4 dimensional ultrasound procedures has not been detected on the fetus and the mother. Three-and-four dimensional ultrasound procedures can be performed since the first months of the pregnancy. In each trimester of the pregnancy, the fetus shows different behaviors and movement characteristics. However, these characteristics can be detected through the three-and four-dimensional ultrasound.     

• Evaluation of fetal anomalies or the suspicion of fetal anomaly:

It provides an opportunity to evaluate the growth and movements of the fetus in addition to the level of sufficiency in the fluid and the blood flow values of the fetus and the placenta, and the functionality of the placenta in performing its duties. Through this ultrasonography, some anomalies, which can be diagnosed between the 18^th and 23^rd weeks, can be determined. Ultrasonograpy, which is performed in these weeks, is very important especially for the expectant mothers, who had a problem in their previous pregnancies (preeclampsia, diabetes, dead birth, fetal growth deficiency etc.).     

• Evaluation of fetal growth and fetal wellbeing:

It provides an opportunity to evaluate the growth and movements of the fetus in addition to the level of sufficiency in the fluid and the blood flow values of the fetus and the placenta, and the functionality of the placenta in performing its duties. Through this ultrasonography, some anomalies, which can be diagnosed between the 18^th and 23^rd weeks, can be determined.

• Amniocentesis:

Amniocentesis is a medical procedure performed by taking a sample from fluid of the fetus in order to determine the chromosomal structure certainly. The sample of fluid is taken through a special needle under the ultrasound. This fluid taken is produced again by the fetus within a few hours. Results of the most frequent anomalies can be obtained within a day. On the other hand, results of the anomalies, which are rarely observed, can be obtained within 2-3 weeks. The risk for abortion, which may be caused by this procedure, may be seen in one of two hundred pregnancies.

• Chorionic Villus Sampling

Chorionic Villus Sampling is a prenatal test in which a cell sample is removed from the placenta in order to determine the chromosomal structure certainly. As it is derived from the same cell root with the fetus, the chromosomal structure can be determined. This procedure can be performed especially between the 11^th and 14^th weeks. Results of the most frequent anomalies can be obtained within a day. On the other hand, results of the anomalies, which are rarely observed, can be obtained within 2-3 weeks. The risk for abortion, which may be caused by this procedure, may be seen in one of two hundred pregnancies.

• Cordocentesis (Fetal Blood Sampling)

Cordocentesis, which is also known as percutaneous umbilical blood sampling (PUBS), is a procedure performed after the 16^th or 18^th week of the pregnancy in order to detect certain genetic disorders of the fetus or infection exposed by the fetus in the mother’s womb if available. Performing this procedure provides an opportunity to obtain the results quickly.    

• Embryo Reduction

Embryo reduction, which is also known as fetal reduction, is the practice of ending the growth by failing the heart of fetus through a special medication in triplet and multiple pregnancies occurred after IVF procedures.

Perinatology Calendar

6 to 11 weeks

 Early pregnancy ultrasound

10 to 12 weeks

 Evaluation of multiple pregnancies, and embryo reduction

11 to 14 weeks

 Nuchal translucency scan

11 to 14 weeks

·         Chorionic Villus Sampling

First trimester of pregnancy

 Three- and four-dimensional ultrasound

16 to 18 weeks

·         Amniocentesis (Sampling from fluid of the fetus)

18 to 23 weeks

 Secondary and advanced ultrasound

18 to 23 weeks

Premature birth scan

18 to 23 weeks and subsequent weeks

 Cordocentesis (Fetal blood sampling)

Second trimester of the pregnancy

 Three- and four-dimensional ultrasound

28 to 32 weeks

 Determination of fetal growth anomalies