Fort Sanders Perinatal Center

Our experienced medical team helps mothers facing a variety of high-risk pregnancy concerns:

• Concerns regarding potential birth defects or abnormalities
• Medical problems such as diabetes, hypertension, asthma, lupus, heart disease, kidney disease or a history of thrombosis
• History of prior pregnancy complications, such as preterm labor, premature rupture of membranes, recurrent pregnancy loss, birth defects or fetal growth disturbance
• Current pregnancy conceived by infertility treatment
• Multiple pregnancy such as twins, triplets or quadruplets

We treat a variety of health conditions such as:

• Diabetes in pregnancy
• Risk of preterm labor
• Hypertension in pregnancy
• Risk of having a child with a birth defect
• Cardiovascular disease in pregnancy
• Family history of genetic disease or birth defects
• Multiple pregnancies
• Complications in previous pregnancies
• Rh sensitization
• Other high-risk pregnancy complications
• Concerns regarding medication taken during pregnancy

For normal pregnancies without significant complications, prenatal appointments and exams are usually scheduled as follows:

• Every month from the 1st week through the 28th week
• Every two weeks from the 29th week through the 36th week
• Weekly from the 37th week until delivery

This schedule may vary depending on your personal medical condition and your healthcare provider’s preference. Additional prenatal care may be necessary if there are any pre-existing medical conditions like diabetes present in the mother, and/or if complications arise while carrying the baby to term.

What happens at a prenatal appointment?

The goals of prenatal care are to provide excellent care for mother and baby during pregnancy and to prepare for delivery. During prenatal visits, tests are performed on both mother and baby to assess any potential risks, treat any maternal or fetal complications, and to keep an eye on the growth and development of the fetus. In addition, counseling and guidance are provided regarding various aspects of pregnancy, including weight gain, exercise, nutrition, and overall health.

A typical prenatal visit may include any/all of the following:

• Weight measurement
• Blood pressure measurement
• Measurement of the uterus to check for proper growth of the fetus
• Physical exam of the mother to identify problems or discomforts, like swelling of the hands and feet
• Urine test to measure sugar and protein levels. This can indicate diabetes or preeclampsia (a condition characterized by high blood pressure, proteinuria, and swelling due to fluid retention). However, swelling does not need to be present to make the diagnosis. And having swelling does not always mean a woman has preeclampsia.
• Fetal heart rate measurement
• Prenatal screening tests like blood tests to check for anemia

We use diagnostic testing to evaluate the health of your baby and check for birth defects. While most babies are born healthy, a small number (1%) are born with major birth defects, and 3-4% are born with minor birth defects that may be caused by genetic, environmental or other factors.

There are ways to estimate risk for birth defects for families with or without chromosomal problems:

• Mother’s age. Women considered to be at an advanced maternal age (older than 35) are at an increased risk for chromosome problems.
• Family history
• Babies with chromosome problems can be born to younger women.

It is important to recognize the distinction between screening tests and diagnostic tests. Screening tests do not provide a yes-or-no answer, but do let a family know if the risk for a condition is higher or lower than expected. Diagnostic tests provide a yes-or-no answer.

Types of Birth Defects

The major categories of birth defects are chromosomal conditions, abnormalities involving a known mutation in a particular gene, structural birth defects unrelated to chromosomal conditions or a specific known gene, and birth defects due to certain maternal infections or environmental exposures.

Diagnostic Testing

Direct examination of chromosomes is required to determine the presence of a numeric chromosome defect, such as Down syndrome, trisomy 13 or trisomy 18. During pregnancy, DNA samples typically are collected through chorionic villus sampling (CVS, typically done between 11 and 13 weeks) and amniocentesis (typically performed between 15 and 22 weeks).

Our genetic counselors are available to provide guidance about different screening and diagnostic testing options that are unique to your needs.

Regardless of age or calculation of risk, we offer the options of CVS or amniocentesis to all pregnant women who desire these tests. Depending upon your insurance plan, the testing may or may not be covered.

We perform prenatal screening to evaluate the health of your baby and check for birth defects. While most babies are born healthy, a small number (1%) are born with major birth defects, and 3-4% are born with minor birth defects that may be caused by genetic, environmental or other factors.

There are ways to estimate risk for birth defects for families with or without chromosomal problems:

• Mother’s age. Women considered to be at an advanced maternal age (older than 35) are at an increased risk for chromosome problems.
• Family history
• Babies with chromosome problems can be born to younger women.

It is important to recognize the distinction between screening tests and diagnostic tests. Screening tests do not provide a yes-or-no answer, but do let a family know if the risk for a condition is higher or lower than expected. Diagnostic tests provide a yes-or-no answer.

Types of Birth Defects

The major categories of birth defects are chromosomal conditions, abnormalities involving a known mutation in a particular gene, structural birth defects unrelated to chromosomal conditions or a specific known gene, and birth defects due to certain maternal infections or environmental exposures.

Our genetic counselors will review your family history to help determine if your baby is at risk for a birth defect.

Prenatal Screening

There are several ways to screen for chromosome defects. Screening tests are performed by ultrasound evaluation and maternal blood tests, either separately or in combination. The following screens are offered at Fort Sanders Perinatal Center:

• First trimester screening
• Maternal Serum AFP screening
• Sequential screening
• Quad screening
• Non-Invasive Prenatal Testing (NIPT)

Our ultrasound team of sonographers have experience ranging from 5 to 30 years in obstetric imaging and are certified by the American Registry of Diagnostic Medical Sonographers. This certification is not required for all sonographers, but the team at Fort Sanders Perinatal Center is dedicated to expertise in women’s health by maintaining required and elective certifications and staying informed of the latest advances in imaging techniques.

In addition, our sonographers have specialized training and certification for early detection of chromosome anomalies and fetal anatomical abnormalities, known as Fetal Nuchal Translucency/Nasal Bone Assessment. This first trimester ultrasound is performed at approximately 12 weeks of pregnancy. They also are certified to perform Maternal Cervical Assessment to aid in prevention of early delivery and miscarriage that otherwise may not be detected.

Our team was the first obstetrical ultrasound department in Knoxville to be accredited by the American Institute of Ultrasound in Medicine in 1996. This is important because AIUM develops educational guidelines and protocols in imaging for medical professionals that ensures our sonographers and physicians are performing obstetrical ultrasound techniques above and beyond the standard of care. We are currently one of the largest maternal-fetal medicine imaging labs in East Tennessee.

Many women develop gestational diabetes during pregnancy and require diabetes counseling. This occurs when a hormone made by the placenta keeps your body from using the insulin as it should. Blood sugar (glucose) then builds up in your blood instead of being absorbed by the cells in your body.

Diabetes education is provided by our Certified Diabetes Educators and includes:

• Overview of pregnancy
• Importance of blood glucose control
• Instruction in blood glucose monitoring
• Nutritional counseling
• Medication management when necessary

We develop an individualized care plan to assist you in successfully managing your diabetes during pregnancy. Our goal is to promote a healthy lifestyle during pregnancy and maintain optimal blood glucose control in order to ensure the best possible outcome for you and your baby.

Genetic counseling gives you information about health concerns that run in your family. It includes a review of family history, health history, and/or pregnancy history.

The goal of genetic counseling is to:

• Check your risk for having a baby with possible health problems
• Explain the cause of a health problem and how it is passed on
• Discuss your personalized pregnancy care plan and what tests are available
• Figure out the outlook of a health problem
• Counseling and support
• Manage your health needs
• Treat a health problem
• Referral to other professionals if necessary

What is a genetic counselor?

Our genetic counselors have master’s degrees in genetic counseling, are licensed by the State of Tennessee Division of Health Related Boards, and are certified by the American Board of Genetic Counseling. They have extensive knowledge in human genetics, genetic disease, patterns of inheritance and birth defects. They also are trained in counseling skills to help you deal with critical decision-making and the emotional effects of a genetic disease.

Who needs genetic counseling?

Some common examples of individuals who seek genetic counseling are:

• Women older than 35 who are pregnant or planning to become pregnant
• Couples with increased risk for birth defects, chromosomal problems or genetic conditions
• Certain ethnicities with increased risk for recessive genetic diseases
• Detection of birth defect (such as cleft lip, club feet, heart defect, or spina bifida), chromosomal or genetic conditions in an unborn baby
• Couples who have a child with a birth defect
• Couples with recurrent miscarriages