Maternal-Fetal Medicine
Associates of  Maryland

Maternal-Fetal Medicine (MFM) or Perinatology is a subspecialty in the field of obstetrics and gynecology. This subspecialty requires three years of additional formal education and clinical experience within an American Board of Obstetrics and Gynecology (ABOG) approved maternal-fetal medicine fellowship program after completing four years of training in an ABOG approved obstetrics and gynecology residency training program. Physicians who specialize in this field have advanced training, knowledge and expertise of medical and surgical complications of pregnancy, obstetrical complications, fetal and / or genetic abnormalities, and their effects on both the mother and fetus. Our subspecialty promotes recognition and awareness of diagnostic and therapeutic options available for improving the health and wellbeing of both mother and fetus in such high-risk pregnancies. Maternal-Fetal Medicine specialists work in collaboration with obstetricians, reproductive endocrinologists, and other primary care providers in providing care for complicated pregnancies, providing consultation, co-management, and direction of care, during, and after pregnancy.

In our Maternal-Fetal Medicine (MFM) practice, the majority of first time patients we see have no risk or only a minimal risk for problems during their pregnancies. They are referred to us for our advanced ultrasound exams, enhanced expertise in genetic testing and ability to diagnose problems early. We have the ability to verify that a pregnancy is proceeding normally; hearing this gives you the peace of mind so critical for a positive pregnancy experience.

Patients are referred for a variety of reasons. This includes women with a poor obstetric history (i.e. multiple miscarriages, stillbirth, preeclampsia, IUGR, preterm labor, or preterm delivery), women wanting to undergo genetic screening or testing, women with medical disorders (i.e. hypertension, diabetes, autoimmune disorders, clotting disorders, seizures) and women with an increased risk for adverse pregnancy outcome (i.e. abnormal maternal serum screen, abnormal cell-free DNA screening, family history of birth defects or genetic disorders, medication exposure, suspected fetal abnormality, disorders of amniotic fluid volume, poor fetal growth, twins, triplets, etc.) ​We also see low-risk or average-risk patients for first trimester risk assessments (first trimester screening) and second trimester fetal anatomy ultrasounds.

Recent studies have shown that women who have had advanced testing performed by medical specialists, such as perinatologists, have a three-fold increase in detection of abnormalities when compared to community based radiology or OB offices. In one recent study done in Las Vegas over a 3 year period and published in the “Journal of Ultrasound in Medicine,” 100% of fetal heart defects requiring surgery were detected; compared with only a 35% detection rate in general obstetrician and radiology centers. By diagnosing problems like this early, we can work with your obstetrician to give you the very best chance at a healthy pregnancy and delivery.

Maternal-Fetal Medicine physicians specialize in the diagnosis, treatment, and care of expectant mothers and their unborn babies who may be at high risk for health problems. Some women require a single consultation before or during pregnancy to evaluate their condition and coordinate their care with their obstetrician, family practitioner, or nurse-midwife who may be less familiar with managing concurrent illnesses or complications of pregnancy. Others may warrant ongoing MFM specialist care, such as monitoring their condition through regular prenatal visits, performing fetal assessments with ultrasound and/or invasive procedures, and participating in delivery. Following delivery, MFM specialists may be consulted to diagnose or manage adverse or unusual pregnancy or postpartum events.

Fetal ultrasound First trimester nuchal translucency screening Chorionic villus sampling / placental biopsy Genetic amniocentesis Umbilical blood sampling Cerclage placement Cervical insufficiency Preterm premature rupture of membranes Recurrent pregnancy loss Fetal growth abnormalities Abnormal genetic screening Multiple gestations High blood pressure / hypertension Preeclampsia Diabetes – pre-existing or gestational Thyroid disease or other endocrine disorders Genetic diseases Kidney disease Gastrointestinal disease Gallbladder disease Infectious diseases Heart disease Metabolic disorders Asthma / pulmonary disease Hematological disorders Thrombophilia (clotting abnormalities)

This varies depending on the reason you were referred, but typically a patient’s first appointment is around 12 weeks gestation for genetic counseling, ultrasound, and a physician consult for a first trimester assessment. If everything is progressing normally, a patient then returns around 18 weeks gestation for a full fetal anatomy ultrasound. If the anatomy scan is completed and everything is looking good, then patients typically follow up with their OB. If we do not see everything we need to at the anatomy ultrasound, then a follow up ultrasound appointment is scheduled in 2-3 weeks. High risk pregnancies require more visits to your doctor for frequent fetal monitoring. The doctor will determine how often you need to be evaluated. As your due date nears your visits will typically increase in frequency. We see each patient as needed, and look at most situations on a case by case basis, as there are many unique factors to each mother and her baby. One thing we can say with certainty is that you will have an ultrasound and see a physician each time you come to our office.

Yes! Dr. Hamersley co-manages your pregnancy with your OB/GYN. Please keep all of your regular appointments with your OB, as we do not deliver babies.

Ultrasound is a test that uses sound waves to create an image of your unborn baby on a video screen. It does not hurt the developing baby. Given its known benefits and recognized efficacy for medical diagnosis, including use during human pregnancy, the American Institute of Ultrasound in Medicine herein addresses the clinical safety of such use: no independently confirmed adverse effects caused by exposure from present diagnostic ultrasound instruments have been reported in human patients in the absence of contrast agents. Ultrasound should be used by qualified health professionals to provide medical benefit to the patient. Ultrasound exposures during examinations should be as low as reasonably achievable (ALARA).

Expect to meet with a Genetic Counselor for about 30 minutes. She will take a detailed family and medical history, and offer screening and testing options based on your history and specific case. These tests are to give us more information about the baby’s health and the mother’s health as well. The tests are usually done via blood draw and do not harm the mother or the baby. After the counseling session, you will have your first trimester ultrasound. The sonographer will measure the fetus from crown to rump length, check for arms, legs, bladder, and the fetal heart rate. The nuchal translucency will also be measured. After these measurements are complete, the doctor will come in to discuss the ultrasound. Finally you will have your blood drawn for whichever genetic tests you have decided to do.

Genetic Counselors are health care professionals with specialized graduate training in the areas of medical genetics and counseling. Genetic Counselors usually work as members of a healthcare team, providing information and support to families who have members with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions. Genetic Counselors also work to coordinate various types of genetic testing and help patients interpret these results.

Review your personal and family medical history Identify possible genetic risks and discuss inheritance patterns Review appropriate testing options Discuss prevention strategies, screening tools and disease management Provide genetics-related information and reliable resources Receive supportive counseling that may help you with topics that arose during the consultation A Genetic Counselor helps to facilitate the decision making process about genetic testing. They help to coordinate all of the testing and call out results, as well as communicate results to your physicians. A Genetic Counselor will help you to interpret and understand what the results mean for your pregnancy and help you navigate the choices and decisions that may come afterwards. In some cases you may speak with a Genetic Counselor once. In other cases you may work with your counselor over time. As questions about your genetic health arise, a genetic counselor is available to help. After your initial genetic counseling appointment the majority of follow-up with the Genetic Counselor will be done via phone calls and email. If you ever feel you need another appointment in person, that option is also available. A consult note detailing everything discussed during your genetic counseling session will be sent to your obstetrician.

Discussion of testing options and types of tests available during pregnancy First trimester risk assessment Discussion of positive and negative test results Carrier screening Personal or family history of a known or suspected condition Abnormal ultrasound findings Advanced maternal or paternal age Recurrent miscarriages Previous pregnancy or child with a genetic condition Medication or teratogen exposure Travel to Zika area prior to or during pregnancy

Cell-free DNA screening for common chromosome conditions Screening for early onset preeclampsia Expanded carrier screening for recessive and X-linked conditions (Cystic fibrosis, Spinal Muscular Atrophy, Tay-Sachs disease, Thalassemia, Fragile X, etc.) Cell-free DNA screening for de novo conditions associated with advanced paternal age Parental chromosome analysis Thrombophilia work up

Nuchal translucency measurement Chorionic Villus Sampling Amniocentesis Fetal karyotype Prenatal microarray Testing for a known familial mutation Fetal anatomy ultrasound Fetal echocardiography

Ask your relatives about medical conditions in the family Gather any medical records related to your concerns Our Genetic Counselor only speaks English. If you do not feel like you can speak English comfortably, please bring an interpreter with you.

Accreditation by the American Institute of Ultrasound in Medicine (AIUM) demonstrates a facility's clinical excellence and its commitment to the highest quality patient care when providing diagnostic ultrasound services. To become accredited, a practice must undergo a rigorous and detailed application process. There are no state or federal laws overseeing the performance of diagnostic ultrasound. AIUM accreditation, which is a voluntary process, gives patients the assurance that a facility is qualified to perform their ultrasound examinations. A patient who goes to an AIUM-accredited practice for an ultrasound examination can be sure of the following: There is adequate space for patient comfort and privacy. There are complete records of every examination, which are available for easy retrieval and review. The length of time records are stored meets or exceeds state-mandated minimums. Policies are in place to ensure patient safety, confidentiality, and prevent transmission of infectious disease. The ultrasound equipment is properly maintained and calibrated. All the physicians and sonographers in the practice have documented training and experience in ultrasound and have the appropriate credentials for the field. The physicians and sonographers have demonstrated that they receive continuing medical education in the specialty. Actual cases and reports have been reviewed by the AIUM and show that both the performance and the interpretation of ultrasound examinations offered by the practice meet or exceed nationally accepted standards. After receiving accreditation, an AIUM-accredited practice must apply for re-accreditation every three years, once again documenting that the level of care it provides continues to meet the AIUM's strict standards. This information was taken from materials distributed by the American Institute of Ultrasound in Medicine.