With over 125 years of combined experience, North Texas Perinatal Associates offer a number of maternal-fetal medicine consultative and surgical services. For more information of each, please click the links provided below:
Chorionic villus sampling (CVS) is a technique for obtaining genetic information about an unborn baby by collecting cells from the baby's placenta. Indications for CVS include an increased risk for a baby with a chromosomal abnormality, a family history of heritable (genetic) diseases, or evidence of fetal abnormalities on a first trimester ultrasound (increased nuchal translucency).
CVS has been available for decades and is as safe as amniocentesis when performed by an experienced physician. CVS is considered to be associated with a pregnancy loss rate of 1:200-1:400 procedures, and, in our experience, the loss rate has been less than 1:400. Early studies of the safety of CVS raised concerns about a risk of injury to the developing baby that included loss of fingers. More recent safety studies have shown that when the procedure is done after the tenth week of pregnancy and when done using modern equipment and techniques, there is not a risk of fetal malformations. CVS can be performed either through the abdominal and uterine walls (transabdominal approach) or through the vagina and cervix (transcervical approach). Both are equally safe. The safest procedure for any mother is the one that can be achieved with the most ease and the least manipulation.
Factors including the location of the placenta will help determine the best approach for each patient. We offer both transabdominal and transcervical CVS between 10 0/7 week and 13 6/7 weeks of pregnancy. If you need to have a CVS for any reason, we are happy to see you and to discuss the specifics of the procedure and the route that would be safest for you and your baby.
Percutaneous umbilical blood sampling (PUBS) and intrauterine transfusion (IUT) are techniques used to sample the baby's blood to evaluate and to treat specific fetal problems. PUBS involves using ultrasound to direct a needle through the mother's abdomen and uterus and into the vein in the baby's umbilical cord to obtain a sample of the baby's blood. IUT is done when the PUBS shows that the baby has anemia (low blood count) and involves transfusing blood through the needle in the baby's umbilical cord to treat the anemia while the baby is still in the uterus.
Fortunately, the need for either of these procedures is rare now as medical breakthroughs such as rhogam for preventing RH disease and middle cerebral artery (MCA) Doppler to assess for fetal anemia have been introduced. Because these procedures are required less often, it is important to find providers who have experience in these procedures. At NTPA, we have a number of years performing these procedures and work diligently to keep up our skills to make the procedure as safe as possible for the mother's and baby's who require it.
Surgical treatment for cervical insufficiency or incompetence, called cervical cerclage, is generally performed utilizing a transvaginal approach during the 12-14 week of gestation. The suture is placed around the upper cervix, in a purse-string fashion, thus, reducing the likelihood of early dilatation and preterm delivery.
Transvaginal cervical cerclage maybe suggested for women with a history of relatively painless premature cervical dilatation which has resulted in a second-trimester pregnancy loss, OR women with a history of cervical surgery (such as a LEEP, LETZ, or cone-biopsy), OR women with a history of other cervical "trauma" (such as D&C, laceration during a prior pregnancy, or rapid delivery of a large infant) OR if prior pregnancy loss is due to an ABNORMALLY shaped uterus (i.e. bicornuate uterus).
While most cervical cerclage procedures are performed at the end of the first trimester or early in the second trimester, an EMERGENT or RESCUE cervical cerclage may also be considered later in pregnancy if the amniotic sac begins to protrude through the cervix OR if the cervix is noted to shorten during the SECOND trimester.
Does it work?
Cervical cerclage SUCCESS is best defined as a term pregnancy, however, relative success is a pregnancy progressing beyond the time of the prior loss and resulting in a living survivor. Cervical cerclage may prevent 85-90% of miscarriages or preterm delivery related to properly diagnosed Cervical Incompetence.
Are their risks to surgery?
While any surgery carries risks, a non-emergent, elective cerclage is considered relatively low risk. Risks include, but may not be limited to: Bleeding, Infection, Damage to the cervix or ADJACENT organs, Preterm Premature Rupture of Membranes (pPTROM), Preterm Labor, Cervical Stenosis (scar causing a permanent narrowing), Late pregnancy Erosion of the stitch into adjacent organs. Anesthesia risks will vary depending on the method employed during surgery, i.e. general, epidural, or spinal anesthesia.
Women who have failed a vaginal McDonald, Shirodkar, or Wurm cervical cerclage OR women who have an AMPUTATED cervix (little or no cervix available for vaginal cerclage) may consider a Transabdominal cerclage (TAC). The TAC is placed above the mother's bladder at the UTERINE ISTHMUS (lower uterus) encircling the CARDINAL and UTEROSACRAL ligaments. The TAC may be placed LAPROSCOPICALLY OR is placed via an abdominal incision (much like a C-section incision) and requires a Cesarean section for delivery of the infant.
Amniocentesis is a procedure used to sample the fluid around the baby while it is still in the uterus. This procedure is typically done after 15 0/7 weeks. Amniocentesis can be used to determine if the baby may have a problem with too many or too few chromosomes, to determine if the baby may have contracted a viral or bacterial infection, or, later in the pregnancy, to determine if the baby's lungs are mature enough to deliver the baby.
Amniocentesis involves placing a needle through the skin on the mother's abdomen and into the uterus and the fluid around the baby. This is done under continuous ultrasound guidance and sterile conditions. Typically, amniocentesis is performed in the doctor's office. The risk of an amniocentesis is the risk of pregnancy loss. Nationally, this risk is quoted as one pregnancy loss for every 200 to 400 amniocenteses performed.
Many studies have shown that the main key to safety in amniocentesis is having the amniocentesis done by someone who has performed lots of amniocenteses. In our hands, we find this to be a safe and useful procedure in situations where there are concerns about the baby and the results may help to manage the pregnancy.
A level II ultrasound is not a 3-D ultrasound but it is a more detailed ultrasound. It is a "targeted" or "diagnostic" ultrasound as opposed to the more general screening level I ultrasound. Specific ultrasound findings must be documented in order to call an ultrasound level 2 versus level 1. Your perinatal physician has specialty training and a broad experience in this type of ultrasound.
It is important to establish fetal well-being in a variety of clinical conditions in which perhaps it might threatened. We establish fetal well-being in several ways, the easiest and cheapest simply being maternal perception of fetal movement. Fetal heart rate variability, ultrasound fetal movement and tone, amniotic fluid levels and Doppler flow studies of umbilical cord blood flow help your perinatal physician establish fetal well-being. Depending on the clinical situation we typically recommend these procedures weekly but recommendations may range from every other week to every day depending on our level of concern.
NPTA will address the specific needs of each couple. If there has been a previously complicated pregnancy due to preterm labor and/or preterm delivery, genetic disorder(s), fetal anomalies, or maternal conditions such as: diabetes, high blood pressure, or recurrent pregnancy loss our Maternal-Fetal Medicine specialist and/or Genetic Counselor will provide a specific outline of your future pregnancy care. Important Lifestyle habits should include, in addition to a well-balanced diet, taking a prenatal (daily) vitamin with folic acid prior to conception, being physically active is of benefit, eliminating smoking, alcohol, and illicit drugs, and avoiding environmental exposures like second-hand smoke, lead, radiation, and litter boxes.
At NTPA, our physicians provide more than their individual training and collective years of experience. Our physicians provide a comprehensive array of diagnostic tests and services which are tailored to meet the specific needs of your pregnancy.