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What types of prenatal screening tests do you recommend?

Many tests are part of routine prenatal care, such as blood type, screening for rubella immunity, screening for common diseases like hepatitis B, sexually transmitted diseases, HIV, and cystic fibrosis. Other screening tests may be offered based on family history, maternal age, or ethnic background, such as sickle cell screening, testing for diseases in Ashkenazi Jewish parents, and various testing for chromosome abnormalities in the fetus. Every pregnant woman is also offered an ultrasound at around 20 weeks to screen the fetus for major birth defects.

What common procedures are used to treat problem pregnancies?

Fetuses can be in distress due to structural abnormalities, inability to grow, low amniotic fluid, problems with the placenta, or an underlying maternal disease. Ultrasound is very helpful for diagnosing these problems. We also use fetal heart rate monitoring. A normal fetal heart rate pattern suggests good oxygenation through the placenta. At times, we use very specialized procedures to diagnose and treat problems in the fetus, such as sampling fetal blood through the umbilical cord, giving a blood transfusion to a fetus in utero, or performing specialized surgery to treat a problem before birth. These specialized procedures are usually done in a tertiary center with specialists trained in these procedures.

What can better genetic testing and other advanced tests reveal?

Genetic testing is changing on an almost daily basis. A new test is now readily available called cell free fetal DNA testing. We are able to analyze fetal DNA from a maternal blood sample. We can determine if a fetus has Down syndrome with 99 percent accuracy from a simple maternal blood sample without performing an amniocentesis, which has a risk of miscarriage. This technology will continue to expand, and we can foresee a wide array of testing becoming available in a few years. It will be possible to determine the entire genome of the fetus, including potential disease in adulthood. Many ethical questions will be raised by the availability of this information.

What guidance would you give a high-risk mother to increase her chances of a healthy pregnancy?

The health of your baby does not start at conception, but long before and is dependent upon the health of the parents. Improve your general health before you become pregnant. If you are overweight, lose weight. Start a healthy diet today, stop smoking, exercise regularly. If you have a medical problem, work with your physician to be at your healthy best before pregnancy. Discuss your plans for pregnancy with your obstetrician long before you become pregnant. If you have issues, request to meet with a maternal fetal medicine specialist to discuss your risks in pregnancy.

What inspired your passion for maternal fetal medicine?

My passion is working with pregnant women to help them achieve the best possible pregnancy with a healthy baby, especially when there are complications such as fetal abnormalities or maternal medical problems.

Vassar Brothers Medical Center
Health Quest Medical Practice, P.C.
21 Reade Place, Suite 1000
Poughkeepsie, NY 12601
TTY /Accessibility: 800-421-1220

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Kimberly A. Heller, MD
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