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Who needs an INPATIENT MFM consultation?

•       All patients going to ICU pregnant, regardless of gestational age 

•       All patients with a medical condition affecting maternal or fetal health and requiring hospitalization for that disease (i.e. IDDM, hyperthyroidism)

•       All patients with concern for fetal anomaly requiring hospitalization

•       If there is an indication for advanced ultrasonography (MCA dopplers, fetal echo, detailed anatomy) that needs to be done urgently (i.e. within 72 hours)

•       Patients with medical or obstetric indication for preterm birth (i.e. severe preeclampsia)

•       Any time your attending tells you to get a consult

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Who needs an OUTPATIENT MFM consultation?

•       Patients with medical co-morbidities in pregnancy

•       Patients with obstetric complications affecting the pregnancy

•       Patients with indications for advanced ultrasonography (i.e. family history of CHD —> fetal echocardiogram)

•       Patients with known or suspected fetal anomalies

•       Patients with fetuses with abnormal growth

•       Patients with multiple gestation - twins of any chorionicity, triplets etc...

•       Patients with complicated or poor outcomes in a prior pregnancy, or history of unexplained stillbirth 

•       Patients with history of preterm birth (please send at 16 weeks!)

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Transfer of care / Complete MFM care

Maternal Neurologic disease

                  Seizure disorder, recent seizures, not controlled with medication

                  Multiple Sclerosis

Maternal Cardiac Disease

                  H/o cardiac surgery

                  Heart murmur / abnormal echocardiogram (not SEM of pregnancy)

                  Marfan syndrome

                  H/o myocardial infarction

cHTN with poor control (ie on multiple medications, increasing medications)

Maternal Renal Disease

                  Nephrotic Syndrome

                  Lupus Nephritis

                  Polycystic Kidney Disease with renal insuffiiciency

                  Chronic renal insufficiency or end stage renal disease

Maternal Endocrine Disease

                  Diabetes: Class B through R

                  Hyperthyroidism, uncontrolled on medication or symptomatic

                  Profound Hypothyroidism

Infectious Disease

                  Patients with ICU admission during pregnancy for sepsis

                  HIV, symptomatic or AIDS

                  Syphilis with PCN allergy

                  TORCH infection

                  Primary HSV infection during pregnancy

Maternal Pulmonary Disease

                  Asthma with poor control

Maternal Autoimmune disease

                  Lupus, Sjogren syndrome

                  Idiopathic Thrombocytopenic Purpura (ITP)

Obstetric history

                  Multiple late pregnancy losses, >3 consecutive SAB

                  History of preterm delivery with birth at limits of viability (23-26 weeks)

                  History of severe preeclampsia or IUGR < 32 weeks

Incompetent cervix, first visit >16 weeks

Hematologic conditions

                  Anemia, severe (HgB <8)

                  Thalassemia

                  Sickle cell disease

DVT, PE in pregnancy

                  Prothrombin gene mutation, antithrombin 3 deficiency, Factor V Leiden

                  Von Willebrands disease

                  Antiphospholipid syndrome

Cancer in pregnancy

Obesity >45 BMI (with other comorbidity)

Gynecologic Disease          

                  Adnexal mass (>10 cm) in pregnancy

Maternal Hepatic or GI disease

                  Chron’s disease / Ulcerative Colitis

                  Cholestasis of pregnancy

Obstetric disease

                  Placental problems: tumor, previa, accreta

                  Isoimmunization (+antibody screen not from Rhogam)

Fetal anomalies – suggestive of aneuploidy

Substance abuse, profound or on methadone replacement

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Consultation only or comanagement

Maternal Neurologic disease

                  Seizure disorder, history of, no seizure for > 6 months not on medication

Seizure disorder, controlled on medication

Maternal Cardiac disease

                  HTN, chronic, on medication and well controlled

                  H/o heart murmur, normal echocardiogram and EKG

Maternal Renal disease

                  Polycystic Kidney Disease with normal BUN/Cr

Maternal Endocrine disease

Gestational diabetes (A1 and A2)

Class B-D DM but well controlled

Gestational / subclinical hyperthyroidism

                  Hypothyroidism

Hyperthyroid, controlled on medication, or new diagnosis asymptomatic

Infectious disease

                  Chronic hepatitis B or C carrier

                  History of syphilis, treated, or current without PCN allergy

                  History of HSV

                  Serology positive for TORCH without evidence of current infection

                  HIV, asymptomatic, on HAART

Maternal Pulmonary Disease

                  Asthma with good control, or history of asthma not on medications

Obstetric history

                  Habitual miscarriage (>2 first trimester losses, or 1 first trimester and one

IUFD > 12 weeks)

                  Prior Cesarean section

                  Prior high-risk pregnancy

                  H/o preterm birth

                  H/o severe preeclampsia or IUGR

                  Incompetent cervix

                  Screen positive MSAFP with no evidence of fetal abnormality

                  Fetal anatomic survey with single soft marker seen (echogenic intracardiac

                                    focus, mild renal pelviectasis, choroid plexus cyst, etc…)

                  Family history of Downs syndrome or congenital heart disease

Hematologic conditions

                  Anemia, mild/moderate (HgB >8)

                  Sickle Cell Trait

Gynecologic disease

                  Adnexal mass, <10 cm

Other

                  Advanced maternal age (>35 at time of delivery), normal genetic screening

                  History of substance abuse, now stopped

                  Smoker

Obesity, BMI <45 with no comorbidities

 

 

ANYTHING an outside provider thinks should have an MFM consultation