Fetal and maternal care in Minnesota Definitions

Abnormal AFP. Alpha-fetoprotein is a protein made by a developing baby. Too much of this protein in a pregnant woman's blood may indicate the baby is at a higher risk of a neural tube defect, such as spina bifida.

To check for abnormal levels of alpha-fetoprotein, a pregnant woman may undergo a maternal serum alpha-fetoprotein (MSAFP) test. This is a blood test done between weeks 15 and 20 of pregnancy. This test measures the amount of the protein produced during pregnancy.

If your screening comes back positive (or elevated), you will need further testing before your doctor can make a diagnosis. It's up to you whether you undergo more testing. If you proceed, you will undergo amniocentesis. Your results will typically be available within two weeks.

Fetal anemia. Fetal anemia occurs when there is a low amount of healthy red blood cells in a developing baby. This condition can occur for a few reasons:

  • The baby may not be producing red cells, possibly related to an infection.
  • The red blood cells are being destroyed.
  • Most commonly, the mother and baby's blood types aren't compatible, a condition called Rh isoimmunization.

If your unborn child is anemic, your doctor may ask you to come in for more appointments and monitoring. The baby might need a blood transfusion through the umbilical cord to treat his or her anemia. During this procedure, which takes place in an operating room, you will be given a mild sedative, perhaps combined with an intravenous pain medication to minimize any discomfort. Your doctor will use ultrasound to guide a needle through your abdomen so that blood can be transfused into the baby's umbilical cord or abdominal cavity.

Fetal anomalies. Abnormalities found in an unborn child are called fetal anomalies, or defects. Many of these conditions can be detected by fetal ultrasound. Congenital heart defects are one of the most common anomalies found during ultrasound. Other anomalies include abnormal brain development, spina bifida, cleft lip and cleft palate, gastroschisis and omphalocele.

If your health care provider wants more details about your baby's health, he or she might recommend additional tests. Or he or she may refer you to a genetic counselor or offer more frequent ultrasound appointments.

Fetal arrhythmia. Fetal arrhythmia is when your baby's heart rate is abnormal. Increased heart rate (tachycardia), decreased heart rate (bradycardia) and skipped beats are different types of arrhythmias. If an arrhythmia is detected, your health care provider may monitor your baby's heart rate more frequently during your pregnancy.

Gastroschisis. During fetal life the bowel develops outside the body at first and then usually returns inside the abdominal cavity. With a rare condition called gastroschisis, the intestine and sometimes the stomach remain outside the abdominal cavity. This leaves the intestines exposed to amniotic fluid and increases the risk of complications, such as poor fetal growth, preterm delivery and stillbirth.

If a fetal ultrasound indicates that your child has gastroschisis, you may need to undergo extra tests during pregnancy to keep a close watch for signs of fetal distress. Shortly after delivery, the part of the baby's bowel that is outside the abdominal cavity is placed in a moistened bag to protect it. What happens to put things right depends on the condition of the baby and the bowel. Options include:

  • Undergoing surgery shortly after birth
  • Allowing time for swelling to decrease and intestinal contents to return to the abdominal cavity

Once the bowel has completely returned to the abdominal cavity, a surgeon closes the hole in the abdominal wall.

Twin reversed arterial perfusion (TRAP) sequence. TRAP is a rare condition of twins that share one placenta. One twin develops normally and the other develops with abnormalities, typically without an obvious heart (acardiac). Because the twins share a placenta and connected blood vessels, the normal twin pumps blood to both twins. Even so, the acardiac twin has no chance of surviving. If not treated, this condition can lead to heart failure in the healthy unborn child.

Treatment focuses on stopping blood flow to the acardiac twin in order to prevent cardiac failure in the healthy baby. One fetal treatment option is radiofrequency ablation, in which a needle is passed through the mother's abdomen into the umbilical cord of the acardiac twin. Energy is sent through the tip of this needle to clot the blood vessels going to this twin.

Twin-twin transfusion syndrome (TTTS). TTTS is a complication of identical twins with one placenta and two amniotic cavities in which the blood flow between the twins is unequal and preferential to one of the twins. The twin who receives more blood is called the recipient twin. The other is the donor twin. If not treated, this condition can lead to both twins dying before birth.

Treatment depends on the stage of your pregnancy at which the condition is detected and the severity of the condition. One treatment option is a fetal laser procedure, in which a fiber-optic scope is passed through the mother's abdomen into the amniotic cavity of the recipient twin. Laser energy is sent through the tip of this scope to cut off the blood vessels causing the problem.

March 31, 2020