Maternal Fetal Medicine: An Overview
Guest: Dr. Jill Mauldin – Obstetrics-Gynecology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Jill Mauldin who is associate professor of OB/GYN. She works in a very interesting area, called Maternal/Fetal Medicine. Dr. Mauldin, what is maternal/fetal medicine?
Dr. Jill Mauldin: Maternal/fetal medicine is the management of high risk pregnancies or pregnancies that are more complicated, either because of maternal problems or because of problems that the baby is having.
Dr. Linda Austin: So, how would a doctor decide that a particular patient is really candidate for your specialty?
Dr. Jill Mauldin: There are certain disorders that, I think, most physicians are just going to refer to us. A lot of multiple gestations are going to be referred to Maternal/Fetal Medicine. Diabetic patients, or hypertensive patients, who are having a more difficult time controlling their disease, are going to be referred to us. Those are the problems for maternal complications. Then, of course, if there is something wrong with the baby that needs some more specialized care, they are going to be referred to us as well.
Dr. Linda Austin: So, do you end up seeing those patients more frequently than a typical patient?
Dr. Jill Mauldin: Absolutely. They usually end up coming about every one to two weeks, to our office.
Dr. Linda Austin: So, you must have a very close relationship with them.
Dr. Jill Mauldin: We do, absolutely.
Dr. Linda Austin: What is the goal with those patients?
Dr. Jill Mauldin: Our goal is, really, to get them as stable medically as we can and, really, to maximize their health so that their disease process is controlled and we are figuring out what we can do to really maximize the health of the baby as well.
Dr. Linda Austin: Does it make a difference in terms of the outcome?
Dr. Jill Mauldin: It sure does. We are able, really, to achieve some really good results. When their blood sugars are under control or their blood pressure is under better control, we are having babies that are doing a lot better.
Dr. Linda Austin: Why is it important to get the blood sugar under control? If it is not under control, what happens?
Dr. Jill Mauldin: Then, the pregnancies are at risk for a number of complications. It could be for having miscarriage, or for having a stillbirth. If their blood sugars are poorly controlled, you are more likely to have a child with birth defects. And, perhaps, depending on how well the blood sugars are controlled, their lungs might not mature as quickly as well.
Dr. Linda Austin: So, is there data that really shows that it makes a difference then?
Dr. Jill Mauldin: Sure.
Dr. Linda Austin: How about hypertension? Why is that important?
Dr. Jill Mauldin: If your blood pressure is not well controlled, you are more likely to have some additional complications during pregnancy, such as preeclampsia.
Dr. Linda Austin: What is preeclampsia?
Dr. Jill Mauldin: Preeclampsia is a disorder that is unique to pregnancy, with having higher blood pressures and spilling protein in your urine. But, really, the only way, then, to get rid of preeclampsia, or to have that disorder resolved, is to deliver the pregnancy. So, of course, we are concerned if you develop preeclampsia preterm. That becomes worrisome for the mom and the baby because now we have a preterm baby that needs to be delivered.
Dr. Linda Austin: Are there things a woman at risk for high blood pressure can do to keep her pressure down as long as possible?
Dr. Jill Mauldin: In general, it is maximizing the medication that she takes and being compliant with it, making sure that she takes it on a regular schedule. You know, on occasion, we are going to have to ask her to remain on bed rest to help that blood pressure do well.
Dr. Linda Austin: But, I would imagine that it really pays off, hard to do when you are going though that, but it really pays off.
Dr. Jill Mauldin: Yes, for a good outcome.
Dr. Linda Austin: Now, how about, you mentioned, multiple gestation, which is, I guess, twins and triplets, and quadruplets? What is the most you have ever delivered?
Dr. Jill Mauldin: The most we have ever delivered, at MUSC, has been five babies at once, or quintuplets.
Dr. Linda Austin: Really? How did the quintuplets do?
Dr. Jill Mauldin: You know, they did well. They did well. It was a mother and a family from Florence, and, to my knowledge, everyone is doing well today.
Dr. Linda Austin: Boy, that must have been a thrill.
Dr. Jill Mauldin: It was very exciting for everybody involved.
Dr. Linda Austin: What are some of the special issues for moms who are carrying two or three, or more?
Dr. Jill Mauldin: We are going to pay lot of attention to see if they are having any signs or symptoms of preterm labor. Obviously, the more infants that you are carrying, you are more at risk to deliver early. The average gestational age for delivering twins is going to be around 36 weeks, about a month earlier than a singleton pregnancy. If you were to have triplets, the average time is going to be about 32 or 33 weeks. So, the more infants that you have, the more likely you are to deliver early. And that is one of the big issues we worry about. We also want to make sure that you gain as much weight as possible, especially early in the pregnancy, to help those babies grow and have as many nutrients as they can.
Dr. Linda Austin: Dr. Mauldin, thanks so much for talking with us today.
Dr. Mauldin: Thank you.
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