14 January 2016

Elements of a Successful Maternal-Fetal Medicine Program

Expectant mothers have a lot on their minds, and those who are facing high-risk pregnancies are under significant stress. They require not only education and counseling but also close, ongoing medical monitoring to mitigate the risks and improve the chances of a safe and healthy delivery. A successful maternal-fetal medicine (MFM) program helps ensure that both mothers-to-be and their developing babies receive optimal care.

The Role of MFM Physicians

In its 2014 special report on the maternal-fetal medicine subspecialists’ role within a health care system, the Society for Maternal-Fetal Medicine (SMFM) defined the scope of maternal-fetal medicine as including specific elements of preconception care, specialized prenatal care, labor and delivery and associated complications, obstetric complications, maternal complications, fetal anomalies, fetal complications, fetal testing, gynecologic issues related to pregnancy and their impact on pregnancy, and postpartum care. The role of the MFM physician complements that of obstetric care providers. MFM subspecialists provide consultations, co-management or transfer of care for complicated patients.

While acknowledging that more research is needed to evaluate the impact of MFM care on outcomes, the SMFM report cited several published examples of evidence of improvement. These include primary MFM subspecialty care of high-risk patients resulting in less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores, and lower perinatal mortality rates, as well as the association of MFM-designed and -led care in a recurrent preterm birth prevention clinic with reduced rates of recurrent spontaneous prematurity and major neonatal morbidity as compared to patients treated by their primary provider.

MFM Services and Procedures

A successful MFM program should provide the following services and procedures:

  • High-Resolution, Targeted Ultrasonography - Including Tele-radiology 
  • Fetal echocardiography
  • Co-Management of multiple gestations
  • Co-Management of preterm labor and other antepartum conditions
  • Co-Management of other maternal medical conditions during pregnancy including but not limited to diabetes, hypertension, autoimmune disorders, thyroid, thrombophilia, etc.
  • Transabdominal Cerclage (TAC)
  • Assessment of Fetal Well-Being
  • Transabdominal/Transvaginal Chorionic Villus Sampling
  • Diagnostic and/or Therapeutic Amniocentesis
  • Percutaneous Umbilical Blood Sampling (PUBS)/Intrauterine Fetal Transfusion (IUT)
  • Transvaginal (McDonald or Shirodkar) and Transabdominal Cerclage
  • Preconception Counseling
  • Referral, when appropriate,  for interventional fetal surgery, including:  sacrococcygeal teratoma, congenital diaphragmatic hernia , open neural,  twin-twin transfusion and laser therapy for fetal tumors  among others

In addition, an MFM program should provide access to an extensive array of screening and diagnostic genetic tests, including:

  • Genetic Counseling and Genetic Carrier Screening
  • First Trimester Nuchal Translucency/Nasal Bone and/or Sequential Screening
  • Non-Invasive Prenatal Testing (NIPT) – Analysis of Fetal DNA in Maternal Blood

Implementation Challenges

A successful MFM program can add a lot of value for a hospital, but setting one up is often challenging. Hospitals that begin building a program without a fair amount of prior MFM-specific management experience among the leadership find it difficult to cost effectively develop and maintain all the necessary capabilities. For this reason, it's not uncommon for hospitals and health systems to rely on more experienced partners to develop and eventually manage their MFM departments; the partner's experience managing dozens of MFM programs often means the difference between profit and loss for the entire department.

Contact Sheridan Healthcare today if you would like to learn more about how we help hospitals across the country develop and manage world-class maternal-fetal medicine programs.