For appointment and information, you can rich us on +90312 219 2233 or +90545 219 2234(whatsapp)

Dr. Burcu KaramürselObstetrician, Gynecologist, Genital Esthetic Surgeon in Turkey
Obstetrics Turkey

Perinatology (Perinatologist)

Perinatology is the term used to describe the follow-up and management of pregnancies that are affected by high risk situations related to the pregnant patient or the fetus.

Perinatology (Perinatologist)

Perinatology (Maternal And Fetal Medicine)-High Risk Pregnancy Follow Up

Perinatology is the term used to describe the follow-up and management of pregnancies that are affected by high risk situations related to the pregnant patient or the fetus.

What is a high risk pregnancy?

A high risk pregnacy is a pregnancy that carries higher risk compared to the normal population caused by certain factors related to the pregnant patient or the fetus. Such pregnacies require specialized follow-up and management plans.

Perinatologists are gynecologists who have received extra fellowship training for the management of such high risk pregnancies.

Which pregnancies are considered as high risk?

During a preconceptional or prenatal visit, when any any of the following risk factors are detected, the pregnancy is considered as high risk pregnancy.

Maternal High Risk Factors:

  • Maternal heart disease
  • Maternal blood clotting disorders
  • Maternal infections which may be teratogenic
  • Maternal kidney disease
  • Maternal cancer
  • Maternal diabetes
  • Maternal thyroid disease
  • Maternal lung disease
  • Maternal gastrointestinal system disease
  • Maternal hormonal disorders
  • Maternal liver,pancreas,gall bladder disease
  • Maternal neurological disorders
  • Maternal rheumatological disorders
  • Maternal dermatological disorders
  • Maternal psychiatric disorders
  • History of recurrent pregnancy loss
  • Cervical insufficiency history
  • History of pregnancy induced hypertension(PIH) or PIH in current pregnancy.

Fetal risk factors:

  • Fetal morphological disorders
  • Fetal genetic disorders
  • Fetal cardiac problems related to rhythm or cardiac morphology
  • Fetus being exposed to teratogens or environmental risk factors
  • Multiple pregnacies
  • Fetal anemia
  • Non-immune hydrops fetalis
  • Intrauterine growth restriction
  • Early membrane rupture
  • Preterm labour
  • Postterm pregnancy
  • Fetal demise

Who is a perinatologist?

A perinatologist is an obstetrician and gynecologist who has received additional fellowship training for 3 years in the field of perinatology (Maternal-Fetal Medicine). They receive special education in invasive fetal diagnostic and therapeutic procedures, advanced fetal ultrasonography and management of hish risk pregnancies.

How is a high risk pregnancy diagnosed?

A high risk pregnancy can be diagnosed by a detailed history taken from the patient during a preconceptional or antenatal visit. During this visit questions related to the patient’s general health status, family history and past obstetric history (previous pregnancies) should be directed.

It is also possible to detect a high risk pregnancy during pregnancy follow-up by certain examination and tests.

What are the causes of high risk pregnancy?

There may be hereditary genetic reasons of high risk pregnancy. Other factors that lead to a high risk pregnancy can be environmental risk factors, maternal chronic diseases,nutritional problems, lack of physical activity ,alcohol, cigarette and drug abuse, exposure to radiation and chemical teratogens.

What are the signs of high risk pregnancy?

Some high risk pregnancies may have no symptoms or signs. However a good antenatal follow-up programme may detect most of the high risk pregnancies.

When a pregnant patient experiences any of the following signs and symptoms, she is adviced to apply to her obstetrician:

  • Sudden weight gain
  • High blood pressure (>140/90)
  • Sudden edema especially on hands and face
  • Constant headache
  • Sudden development of blurred vision
  • Right upper quadrant pain
  • Dyspnea (shortness of breath)
  • Decreased urine output or anuria (no urinary output)
  • Vaginal bleeding
  • Freqent urination and polydipsia (urge to drink too much water)
  • Dry mouth
  • Chest pain
  • Decreased fetal movements or loss of fetal movements
  • Palpitations
  • Feeling too tired
  • Dizziness
  • Intractable nausea and vomitting

What are the high risk pregnancy tests?

  • Second level ultrasound
  • Obstetric doppler ultrasonography
  • Cervical length measurement by ultrasound
  • CVS, amniocentesis and cordocentesis
  • Biophysical profile score
  • Maternal cell free fetal DNA test
  • Gestational diabetes screening
  • Infection Screening

1. Second Level Ultrasound

It is a detailed ultrasound examination performed by a perinatologist usually around 20-22 weeks of gestation to detect congenital fetal malformations.

2. Obstetric Doppler Ultrasonography

Several maternal and fetal blood vessels can be examined by a perinatologist using a Doppler ultrasound machine to detect certain high risk conditions.

Obstetric doppler ultrasonography is most commonly used for the detection and follow-up of pregnancies affected by intra uterine growth restriction (IUGR),screening for pregnacies that are at high risk for preeclampsia and IUGR, detection and follow-up of fetal anemia in pregnancies affected Rh isoimmunisation.

3. Cervical Length Measurement by Ultrasound

Especially for pregnacies that are at high risk for premature labour, serial ultrasound examinations may be performed to measure cervical length, detect cervical opening and funneling.

4. CVS, Amniocentesis and Cordocentesis

These are invasive diagnostic tests mostly used to detect fetal congenital genetic disorders. CVS (chorionic villus sampling) is the sampling of placental tissue whereas amniocentesis takes a sample from the amniotic fluid and cordosentesis takes a sample from the umbilical cord blood.

Cordosentesis can also be used for therapeutic purpose when fetal anemia is diagnosed and serial fetal transfusions are necessary in pregnancies affected by RH isoimmunisation.

5. Biophysical Profile Score

It is the ultrasound test combined with NST (non-stress test) performed during the third trimester to evalaute fetal well-being. There are five parameters of the test which are:

  • Fetal respiration
  • Fetal tonus
  • Fetal movements
  • Amniotic fluid volume
  • NST

6. Maternal Cell Free Fetal DNA Test

It is a very sophisticated test used to screen for fetal chromosomal malformations from a sample of maternal blood. It uses advanced technology to discriminate fetal DNA in maternal blood. When there is ahigh risk test result, the patient may be referred to a perinatologist for invasive tests to diagnose chromosomal abnormalities.

7. Screening For Gestational Diabetes

Oral blood glucose tolerance test (OGTT) should be offered to all pregnant patients for the screening of gestational diabetes. OGTT should be offered as early as possible during pregnancy to patients who are at high risk for gestational diabetes. Low risk patients can have the test at 24-28th gestational week.

8. Infection Screening

Maternal blood serological screening for HIV, syphilis, Toxoplasma, CMV and Rubella is possible. These infectious agents are responsible for some teratogenic fetal malformations. If there is an active infection detected during pregnancy, the patient shoud be referred to a perinatologist.

How is a high risk pregnancy followed up?

High risk pregnancies should ideally be followed up by a perinatologist. Depending on the present risk factor and its severity, the patient may be followed up in the outpatient perinatology clinic or may be hospitalised. Outpatient follow-ups may be as often as twice a week for some high risk cases.

For some high risk prengancies, intrauterine medical or surgical interventions may be necessary.

Another task of the perinatologist is to manage the correct timing of delivery and to prepare the neonatal intensive care unit and tertiary center facilities before the baby is born.

Who is qualified to follow up high risk pregnancies?

Perinatologists (maternal fetal medicine specialists) are qualified to follow up high risk pregnancies.

Is maternal age a risk factor in pregnancy?

Maternal age is a risk factor in pregnancy. Pregnancies under 18 and over 35 years of age are considered as high risk.

Pregnacies over 35 years of age are associated with the following risks:

  • Gestational diabetes
  • Pregnancy induced hypertension
  • Thromboembolic disorders
  • Increased incidence of cesarean section
  • Chromosomal anomalies
  • Congenital malformations
  • Premature labour
  • Small for gestational age infants
  • Placenta previa
  • Ablatio placenta
  • Risk of abortion
  • Perinatal death
  • Intrauterine fetal demise
Update Date: 30.01.2024
Burcu Karamürsel, MD
Dr. Burcu Karamürsel
Burcu Karamürsel, MD
The content of this page is for informational purposes only.
Please consult your physician for diagnosis and treatment.

* Please enter the form fields, your information is kept confidential.

Burcu Karamürsel, MDDr. Burcu KaramürselObstetrician, Gynecologist, Genital Esthetic Surgeon in Turkey
+90312 219 2233+90545 219 2234
  1. Dr. Burcu Karamürsel
  2. Dr. Burcu Karamürsel
  3. Dr. Burcu Karamürsel
  4. Dr. Burcu Karamürsel