Maternal and Fetal Medicine

The Maternal and Foetal Health is a more specialized area of obstetrics, which treats diseases of the pregnant woman and the unborn foetus.

The Specialist in Maternal and Foetal Health treats 2 patients at the same time - the pregnant woman and the unborn foetus, working together with the pregnant woman, her family and the medical team in order to achieve the best possible result.

This specialist monitors families that have had bad experiences in the past with previous pregnancies, mothers with chronic diseases, and women who develop unexpected problems during pregnancy.

Prenatal Consultation

Before pregnancy, the Specialist in Maternal and Foetal Health advises women with chronic illness who want to fall pregnant, or who have had bad outcomes in previous pregnancies.

In a prenatal consultation the Specialist reviews the medical and obstetric history, in order to plan an optimal strategy for the next pregnancy

Genetic Screening, Ultrasound and Prenatal Diagnosis

The specialist in Maternal Health uses ultrasound and blood tests to see and evaluate the developing foetus, working together  with a genetics expert to perform screening tests for chromosomal abnormalities (trisomy 13, 18 and 21).

Problems in Pregnancy

Women who have had bad experience with previous pregnancies, and those that developed unexpected problems during pregnancy.

Recurrent Miscarriages womb before the birth of the foetus).

Preterm delivery

Ultrasound and clinical screening of preterm delivery, prevention therapy (progesterone, pessary) or surgical (cervical stapling).

Hypertension

Sometimes in the course of normal pregnancy blood pressure may rise, leading to Gestational Hypertension, HELLP Syndrome and Pre-Eclampsia.

Haemorrhage

During pregnancy vaginal bleeding may occur due to problems of the placenta Pacenta Previa (when the placenta covers the cervix) placenta accreta, Increta or percreta (when the placenta has adhered to the uterus) and placental abruption (when the placenta detaches itself from the womb before the birth of the foetus).

Health Problems of the Mother

Pregnancy can worsen existing chronic diseases such as High Blood Pressure, Diabetes, Kidney Diseases.

Cardiovascular

During pregnancy the mother's heart beats for two. The amount of blood that is pumped in the later stages of pregnancy increases almost 50% creating cardiac alteration in the women.

• Congenital Heart Disease;
• Arrhythmia;
• Valvular Disease;
• Cardiomyopathy;
• Pulmonary Hypertension;
• Coronary heart disease.

Lung Diseases

During pregnancy women breathe more deeply, inhaling additional oxygen and exhaling as much carbon dioxide. Pregnant women with chronic respiratory problems may not be able to do manage this.

• Asthma;
• Pneumonia;
• Tuberculosis;
• Cystic fibrosis;
• Influenza.

Obesity

Being overweight might increase the risk of developing diabetes, hypertension, and malformations in the foetus.  A pregnant woman that is overweight needs additional and targeted surveillance.

Endocrine Glands

Hormonal changes during pregnancy alters the way the body responds to stress, regulates sugar and controls the flow of nutrients such as  calcium and vitamin D. Women with Endocrine Gland pathology need to adjust  their therapy during pregnancy.

• Addison's disease;
• Diabetes mellitus;
• Thyroid Diseases;
• Parathyroid Diseases;
• Pheochromocytoma.

Digestion

During pregnancy the digestive system becomes slower in order to absorb the necessary nutrients for the development of the foetus. These changes contribute to morning sickness, and may aggravate existing conditions such as gallstones in the gallbladder.

• Hiperémeses Gravidarum;
• Liver Cholestatic;
• Ulcerative Colitis;
• Crohn's Disease;
• Pregnancy after liver transplant;
• Pancreatitis.

Blood

In the final stages of pregnancy the woman's blood volume increases about 50%. Blood clots are formed more easily in pregnancy to reduce the risk of bleeding during delivery. Women with bleeding disorders may require special care to keep mother and foetus healthy.

• hemoglobinopathies;
• Sickle cell Anemia;
• Thalassemia;
• Von Willbrand Disease;
• Venous Thromboembolism and Anticoagulation;
• Thrombophilia.

Kidneys

In pregnancy the kidneys work in overload to filter harmful substances from both the mother and foetus.

• Renal Transplants;
• Nephropathy;
• Chronic Kidney Disease.

Brain

Hormonal changes and increased blood volume can worsen or improve neurological problems in women.

Stress and hormonal changes can alter psychiatric problems.

Some medications for these conditions may affect the health of the foetus.

For Psychiatric and Neurological diseases in the pregnant women it is necessary to adjust therapy in order to maintain a healthy mother, minimizing the risk to the foetus.

• Seizures;
• Headache;
• Arteriovenous Malformations;
• Multiple Sclerosis;
• Myasthenia Gravis;
• Diabetes insipidus;
• Drug Abuse;
• Depression;
• Other Psychiatric Diseases;
• Domestic violence.

Immune System and Infection

Pregnancy alters a women’s immune system so that the foetus is not rejected. These changes might increase infection risks. Infections can cause foetal malformations requiring specialized treatment during pregnancy.

• Infectious disease - Hepatitis A, Hepatitis B, Hepatitis C, HIV;
• Autoimmune diseases - Anti-phospholipid syndrome, lupus erythematosus.

Emergency Surgery

When a surgical emergency occurs during preganancy, the Specialist collaborates with the surgeon to ensure the health of mother and foetus.

• Trauma;
• Critical Medical Care;
• Appendectomy;
• Cholecystectomy.

Bone, Cartilage and Skin

• Marfan's Syndrome;
• Musculoskeletal Dysplasia;
• Dermatoses.

Cancer

Foetal Malformation

Improvements in ultrasound, prenatal diagnosis and treatment have made it possible to detect and in some cases treat some birth defects before birth.

• Central Nervous System;
• Spina bifida;
• Chest;
• Heart (structural, arrhythmias);
• Gastrointestinal;
• Genital;
• Kidneys;
• Skeletal Dysplasia;
• The Umbilical Cord;
• Chromosome problems (Trisomy 21, Trisomy 18 and Trisomy 13);
• Exposure to drugs and chemicals.

Fetal Complications

Multiple Pregnancy

Pregnancy with more than one foetus increases the risk of preterm birth, foetal growth problems due to the mother’s uterus having to distend to accommodate more than one foetus.   When two foetuses share the same placenta keeping both healthy, presents an additional challenge.

Foetal Growth Problems

• Foetal Growth Restriction
• Foetal Macrosomia

Infections

• Cytomegalovirus
• Parvovirus
• Toxoplasmosis
• Chicken Pox

Immunization

Foetal Testing and Treatment

Antenatal Foetal Monitoring

Ultrasound with 2D foetal  heart monitoring, foetal movement, Amniotic fluid.  Ultrasound Doppler to measure blood flow through the umbilical cord, foetal brain and foetal heart. These tests help decide whether the pregnancy can continue to evolve or whether it is necessary to induce birth.

Ecological Monitoring of Amniotic Fluid

• Oligoamnios
• Hydramnios

Post Partum

Specialty Procedures carried out at the HPA Health Group

• Obstetric Ultrasound;
• Early Pregnancy Assessment;
• First Trimester;
• Morphological Ultrasound;
• Growth Assessment Ultrasound;
• Fluxometry;
• Related Exams;
• Screening for Diabetes;
• Screening for Chromosome Diseases;
• Preterm Birth Screening;
• Screening for Preeclampsia;
• Diagnosis of Chromosome Abnormalities;
• Diagnosis of Metabolic Diseases.

Main pathologies/diseases

• Diabetes type 1 and 2;
• Lupus;
• Arterial hypertension;
• Epilepsy;
• Asthma;
• Twin pregnancy;
• Triple pregnancy;
• Placenta previa;
• Hydramnios;
• Oligoamnios;
• Spina bifida;
• Onfalocelo;
• Heart malformations.

Common Symptoms

• Breathlessness
• Respiratory Difficulties
• Headache
• Seizures
• Bleeding