Perinatology

Definition

Perinatology is the field of medicine concerned with the diagnosis, evaluation, and management of complicated pregnancies. A physician who practices this specialty is commonly called a perinatologist or a maternal-fetal medicine specialist.

Maternal-fetal medicine specialists are obstetrician-gynecologists who complete additional formal fellowship training in the management of high-risk pregnancies. In the United States, maternal-fetal medicine fellowship training is generally a 36-month, or 3-year, educational program after obstetrics and gynecology residency.

What does a perinatologist do?

Perinatologists often work together with general obstetricians, midwives, family physicians, genetic counselors, neonatologists, and pediatric subspecialists. Depending on the clinical situation, perinatology services may include:

• Consultation for medical conditions in pregnancy, such as diabetes, hypertension, kidney disease, autoimmune disease, thyroid disease, or cardiac disease
• Evaluation and management of prior pregnancy complications, such as preeclampsia, fetal growth restriction, preterm birth, stillbirth, or recurrent pregnancy loss
• Care of multiple gestations, including twins and triplets
• Detailed fetal anatomic ultrasound and targeted evaluation of suspected fetal anomalies
• Fetal growth assessment and Doppler surveillance
• Genetic counseling coordination and diagnostic procedures such as chorionic villus sampling or amniocentesis
• Fetal monitoring and antenatal testing for pregnancies at increased risk
• Coordination of delivery planning when maternal or fetal complications are present
• Referral for fetal therapy or fetal surgery when appropriate and available at specialized centers

When may referral be helpful?

Referral to a perinatologist may be helpful before pregnancy, during pregnancy, or after an abnormal screening or ultrasound result. Common reasons include preexisting maternal disease, medication exposure, abnormal genetic screening, fetal structural findings, growth concerns, multiple gestation, or a history of serious pregnancy complications.

A referral to maternal-fetal medicine does not always mean that something is wrong. In many cases, the goal is to clarify risk, provide targeted evaluation, and coordinate care with the primary obstetric clinician.