Maternal Fetal Medicine

This week I have been on the Maternal Fetal Medicine (MFM) service. MFM is a specialty fellowship that some OB/GYN doctors do to get specialized training in the management of high risk / complicated pregnancies. These pregnancies include many different scenarios. For example they manage complicated multiples, drug addicted pregnancies, pre-eclampsia, pre-term labor pregnancies, maternal disease / illness pregnancies, etc. If a pregnant women is being cared for by her regular OB/GYN and he/she determines that there are or will be complications in the pregnancy then they will refer the mother to a MFM specialists. Some regular OB/GYN's may continue to manage high-risk pregnancies but usually when it becomes too complicated they will refer out. MFM doctors spend all of their time managing difficult pregnancies with complications. 

I liked this service because most of the cases were interesting. The mothers I saw and helped with their treatment would have lost their pregnancies 20 years ago. However because of advances is knowledge and technology we are now able to help a lot of these patients have successful births. I would see women in the MFM clinic all day that were either regular MFM patients that we were monitoring or they were new patients referred to MFM to be evaluated. I would  ultrasound the mother's fetus and measure the amount of amniotic fluid, check the cervix and then make management discussions based on the findings. I would present my findings to the MFM attending physician and he would check my work to make sure I had the correct measurements and interpretations.

I saw pregnant drug abusers, diabetics, cancer patients, pre-eclampsia, seizure disorders, triplets, quadruplets, heart failure, kidney disease, and many other diseases. All of these patients had one extra complication; they were pregnant. With the proper management many of these mothers will go on to have a fairly normal birth. However there were also many who would end up with fetal demise or severe complications that would affect the mother and the fetus. MFM believes that you treat the mother first and then the infant. This is a complicated and controversial. Some of these cases were sad and involved difficult scenarios where entire families were involved and concerned. 

I did some many ultrasound evaluations this past week that I feel pretty confident in using an ultrasound to evaluate pregnant patients. I can determine the age of the fetus, the sex of the fetus and many irregularities with ultrasound. I am glad I had this opportunity and the attending physician gave me a lot of autonomy to learn by doing.