High Risk Pregnancy

• Abnormal Alpha-fetoprotein (AFP) blood test result 
• Multiple pregnancy
• Recurrent preterm labor and delivery
• Premature rupture of membranes (PPROM)
• Recurrent miscarriages
• Fetal (birth) anomalies
• Types of chromosome abnormalities
• Suspected fetal growth restriction (baby not growing enough) 

Our board-certified genetic counselors will work with you to identify risk factors involved with your pregnancy and how best to treat and support you and your baby.

Who should consider prenatal genetic counseling? 

• Women aged 35 and older
• Women who have had abnormal results from prenatal screening tests
• Women concerned about an exposure, such as medications or infection, during pregnancy
• Couples with a family history of a genetic condition
• Couples who have experienced multiple miscarriages
• Couples who have experienced infertility
• Women who are known carriers of a genetic condition 

Your genetic counselor will explain: 

• The risk of fetal abnormalities and further testing options
• The chromosome abnormality, birth defect or genetic condition of concern
• The factors involved in decisions about carrier or prenatal testing 

If you choose to undergo testing, your genetic counselor will:

• Coordinate the tests within Legacy Health
• Share the test results with you and your referring physician 
• Provide resources and educational materials 
• Help educate you to make the best decision for your family 

We evaluate the mother, the fetus, the family history and the ethnicity of the parents to assess the risk for problems. We use blood tests, ultrasound, diagnostic tests (when needed) and genetic counselors to assess your pregnancy and screen for issues.

Screening tests
Screening tests are used to assess risk. It is important to understand that screening for risk is different from making a diagnosis. The result of a screening test is a risk level or chance, such as “1 in 500” or “1 in 10.” Prenatal screening tests include ultrasound, blood tests and examining your medical and family histories. These tests can generally be performed without posing any risk to a pregnancy.

A screening test will never identify 100 percent of babies with a problem. If you are identified to be at higher risk for a problem by a screening test, a member of our staff will discuss the issue and the follow-up options with you. Keep in mind that most people identified to be at higher risk by a screening test go on to have a healthy baby.

Diagnostic tests
While a screening test estimates the probability of an issue, a diagnostic test gives a “yes” or “no” answer. Diagnostic tests can specifically answer the question of whether a fetus has a certain chromosomal condition. These tests are invasive and carry a risk for pregnancy loss.  We can test for many conditions, including Down syndrome, but these tests are generally reserved for those couples that have a known risk factor for a specific condition.

If you are in a risk group for which a diagnostic test may be indicated, genetic counseling will be offered to ensure that you are informed about the risks, benefits and limitations of these procedures, as well as any alternatives. 

If you are not in one of these risk groups but simply would like more detailed information, you can request genetic counseling. It is important to understand that no test can identify all birth defects prior to delivery.

Ultrasound imaging
Ultrasound is used throughout pregnancy. With these detailed views, the majority of major birth defects can be diagnosed and signs of a chromosomal or genetic problem can be assessed. 

We recommend that all pregnant women have at least one ultrasound at 18 to 20 weeks to look at fetal growth and anatomy. 

Ultrasound is extremely valuable for assessing the due date, the number of fetuses, amniotic fluid, cervix and the anatomy and growth of your baby. Our specialists at the LMG Maternal–Fetal Medicine recommends that all pregnant women have at least one ultrasound at around 20 weeks to look at fetal growth and anatomy. Even if there are no known risk factors, sometimes all the organs and parts of a baby do not form properly. The majority of birth defects can be seen with ultrasound, and other signs of problems can be assessed.

We recommend a detailed ultrasound and genetic counseling for women who:

• Will be 35 or older at the time of their delivery, or 32 with a twin pregnancy
• Have had a previous child (or fetus) with a chromosomal problem
• Have had an increased risk for a problem identified by a screening test
• Are a known carrier of a genetic problem or chromosomal rearrangement (mother or father)
• Have a family history of a genetic or structural problem in a child
• Have findings or suspected findings on an ultrasound
• Are at increased risk for carrying certain genetic conditions based on their ethnic background

You will receive the results of your ultrasound before leaving our office, and if a problem is found or detected, you'll receive detailed information and the option of genetic counseling.

LMG–Maternal–Fetal Medicine is accredited by the American Institute of Ultrasound in Medicine (AIUM), demonstrating our commitment to the highest quality patient care when providing diagnostic ultrasound services. Tests are conducted by experts in cytogenetics at Legacy Laboratory Services , which employs state-of-the-art technology and adheres to the highest level of quality assurance. Our ultrasonographers have all passed the American Registry of Diagnostic Medical Sonographers exam following their clinical internships.

If you have questions or concerns about your pregnancy, please talk to your provider about a referral. Call us at 503-413-1122 if your provider needs help making this referral.