The Perinatal Center at John Randolph
Perinatology is a subspecialty of obstetrics and gynecology. In the Perinatal Center at John Randolph, perinatologists assist obstetricians, midwives and other health care providers in delivering individualized, risk-appropriate care for pregnant women at risk for adverse maternal, fetal or neonatal outcomes. Our Perinatology Center is located on the third floor of the Family Life Center at John Randolph.
Pregnancy risk factors include a history of recurrent pregnancy loss, history of premature labor and/or birth, history of an underweight baby, presence of a multiple pregnancy, and chronic medical illnesses such as chronic hypertension or insulin-dependent diabetes mellitus, renal disease, systemic lupus, or Rh disease.
Our Services
Perinatal Counseling and Patient Education
During Perinatal Counseling, the perinatologist evaluates and provides advice to women who want to have a baby but who worry they may be at risk for complications. This group includes women who have an underlying medical illness such as diabetes or hypertension or those who must consider the possibility of genetic complications. The perinatologist provides all pertinent information needed to assist couples in making informed decisions, and then provides guidance and support for the chosen course of action.
Prenatal Diagnosis
Many new techniques allow doctors to identify and monitor potential problems with a pregnancy. These procedures include:
- First Trimester Sonographic Evaluation
- Identification of pregnancy location and number
- Assessment of viability
- Gestation age
- Screening for Down's Syndrome
- Second Trimester Sonographic Evaluation
- Screening for Down's Syndrome and other genetic abnormalities
- Screening for structural birth defects, including spina bifida, heart defects, cleft lip and palate, and skeletal abnormalities
- Invasive Prenatal Diagnostic Testing
- Amniocentesis
- Chorionic villus sampling (CVS)
John Randolph's center also features state-of-the-art 4D Ultrasound.
Who benefits from prenatal diagnosis?
Women age 35 or older at time of delivery, for they have a greater chance of having an infant with a chromosomal abnormality, primarily Down's syndrome.
Couples who have already had a child with a birth defect, such as neural tube defect (spina bifida).
Couples who have already had a child with certain genetic disorders or have a family medical history of certain genetic disorders such as Down's syndrome, sickle cell disease, cystic fibrosis, Tay Sachs disease, or others.
Families in which either parent is a carrier of a genetic condition or chromosomal rearrangement.
Women who have an abnormal maternal-serum screening test including either abnormal maternal-serum alpha-fetoprotein, HCG (human chorionic gonadotrophin) or estriol.
Women who have amniotic fluid or fetal abnormalities detected by obstetrical ultrasound or targeted fetal imaging.
Fetal Surveillance
In the late second and early third trimester, many pregnancies at risk for adverse outcomes have been shown to benefit from close fetal surveillance.
The nonstress test is an assessment of the change in the baseline fetal heart rate following fetal movement. A small transducer is placed on the mother's abdomen and the fetal heart rate and fetal movement are recorded. A healthy fetus' heart rate increases with movement.
Ultrasonic evaluation of fetal behavior, known as the biophysical profile, is an addition to the nonstress test. Biophysical profile includes a 30-minute evaluation of fetal well-being and includes an assessment of amniotic fluid volume, fetal breathing, fetal movement, and fetal muscle tone.
These are routine tests of fetal well-being and are very reassuring signs in a high-risk pregnancy. There are other methods of assessing fetal health in utero. These include doppler flow evaluation and the contraction stress test.
Pre-term Delivery Risk Monitoring
Women with prior preterm birth, multifetal gestation, prior cervical or uterine surgery or other risk factors for early preterm delivery may benefit from transvaginal sonographic evaluation of cervical anatomy. Patients with early cervical change may be offered transvaginal or transabdominal cerclage procedures in an attempt to prolong gestation. Patients with a wide variety of medical conditions (diabetes, chronic hypertension, systemic lupus erythematofis, etc.) may benefit from frequent evaluation.
Complications Management
Women carrying more than one fetus or those who experience preterm labor need careful medical monitoring. Those with cervical incompetence benefit from advanced surgical procedures.
Gynecologic Services
Although perinatology deals primarily with issues of pregnancy, the field has some applications for other women as well. From pelvic ultrasound to saline infusion sonography, a number of different procedures allow the perinatologist to help women with pain and abnormal bleeding. Specific tests allow physicians to visualize intrauterine structures, assess the endometrium, and identify fibroids and polyps.
Staff
Affiliated physicians include:
- James T. Christmas, M.D.
- Barbara H. Head, M.D.
- Rodrick N. Love, M.D.
- Robert E. Petres, M.D.
Insurance
The obstetrical field has well-established guidelines that govern insurance payments. Perinatal care is usually covered since it prevents costly complications at a later date.
Click here to learn more about prenatal exams.
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