Perinatology (High Risk Pregnancy) is the branch of science that deals with the health of the mother and baby during pregnancy. It is to plan the appropriate treatment by determining risky situations during pregnancy through various tests and ultrasonography examinations. With a detailed ultrasound examination, the condition of the baby in the womb, the possibility of ectopic pregnancy and the amount of amniotic water the baby is in are evaluated and studies are carried out to ensure a healthy process.

What is Perinatology (High Risk Pregnancy)?

Perinatology (High Risk Pregnancy) is a sub-branch of gynecology and obstetrics. His main interest is the fetus and mother. It is the specialty of problematic pregnancies or situations that require specialized care and treatment due to high risk during pregnancy. People who specialize in this field are called “Perinatology Specialists”.

Perinatology specialists follow up complications during pregnancy such as hypertension (pregnancy intoxication), diabetes (diabetes mellitus), as well as pregnancies that accompany existing diseases of the mother.

It provides management of conditions such as multiple pregnancies, fetal growth restriction, premature birth and recurrent pregnancy loss. He applies advanced ultrasonographic scans and diagnostic methods in suspicious cases. After making the diagnosis, he treats the conditions that can be treated.

What is High Risk Pregnancy?

High-risk pregnancy is a situation that may threaten the health of the baby or mother due to some health problems during pregnancy.

Who is at Risk During Pregnancy?

• Previous miscarriages, abortions or surgical procedures
• In vitro fertilization pregnancies
• Pregnant women whose pregnancy is not planned and who use cigarettes, alcohol or drugs in the first months of pregnancy
• Pregnant women who are under a certain weight or height
• Pregnant women who have one or more children
• Pregnant women with previous chronic diseases (e.g. diabetes, hypertension, asthma)
• Pregnant women expecting one or more babies
• Pregnant women with recurrent pregnancy loss
• Pregnancies under 18 years of age
• Pregnancies over 35 years of age
• Consanguineous marriages
• The expectant mother is overweight

Which Patients Does the Perinatology Department See?

The perinatology department provides services for pregnant women and newborns in order to prevent or solve potential health problems by monitoring the health of the baby and mother. The perinatology department provides services for the diagnosis and treatment of various problems such as the following conditions:

• Health problems of mother and baby during pregnancy
• Presence of chronic diseases of the mother such as diabetes, hypertension, kidney disease
• Important health problems of the mother such as high blood pressure, pregnancy poisoning, diabetes during pregnancy
• Threatened miscarriage (bleeding during pregnancy)
• Cervical insufficiency
• Early water breaking during pregnancy
• The baby’s water level is less or more than normal
• Multiple pregnancies (twin, triplet pregnancy)
• Risk of premature birth
• Blood incompatibility
• Presence of risk in screening tests
• The baby’s partner comes first and is attached to the uterus
• Developmental delay in babies
• Congenital anomalies in babies (congenital hereditary anomalies)

What procedures and examinations are performed in the Perinatology (High Risk Pregnancy) Department?

• Ultrasonographic Procedures
• Diagnostic Procedures
• Screening Tests
• birth procedures
• Surgical Treatments in the Womb

Ultrasonography

Ultrasound is called sound waves traveling at a frequency above 20,000 hertz (cycles per second).

Ultrasonography in prenatal care includes fetal anatomical evaluation in the first and second trimesters of pregnancy and specialized studies to identify abnormalities. An ultrasonography evaluation performed according to the standards recommended by international and national societies provides vital information about the anatomy, physiology, development and well-being of the fetus.

First Trimester Ultrasonography

The purpose of ultrasonography performed during this period is;

• Detection of intrauterine pregnancy
• Evaluation of suspected ectopic pregnancy
• Identifying the cause of vaginal bleeding
• Evaluation of pelvic pain (groin pain)
• Calculation of gestational age
• Diagnosis and evaluation of multiple pregnancies
• Detection of heart activity
• Assisting in locating and removing intrauterine devices
• Evaluation of fetal anomalies in high-risk patients
• It is the measurement of nuchal translucency for Down syndrome screening.

Crown-rump distance (CRL) is the most accurate biometric determinant of gestational age. This measurement, if done carefully, determines the gestational age with a difference of 3-5 days. Gestational sac by transvaginal sonography from the 5th week; An embryo with heart activity can be imaged reliably starting from the 6th week.

Nuchal Transparency (NT)

Nuchal translucency assessment, which is a part of first trimester chromosomal anomaly (Down syndrome) screening, is of great importance in the evaluation of pregnancies that undergo first trimester ultrasound examination.

It is the widest thickness of the transparent subcutaneous tissue area between the skin and the soft tissue lying on the fetus’s spine at the back of the neck. 11-14. It is measured using certain criteria between weeks. With increased nuchal translucency, there is an increased risk for various structural anomalies, including fetal chromosomal anomalies (Down syndrome) and heart abnormalities.

Second Trimester Ultrasonography (Detailed Ultrasonography)

If abnormal findings are obtained in the standard ultrasonography examination, a detailed anatomical evaluation is performed with a targeted examination when an anomaly is suspected as a result of the screening test or in the medical history. Targeted examination is performed and interpreted by an experienced operator. In addition, it is applied to all pregnant women to detect congenital organ defects of the baby.

The sensitivity of sonography for second-trimester fetal anomaly screening varies depending on factors such as gestational age, mother’s body structure, fetal position, device features, examination type, operator’s skill, and specific anomaly.

Situations requiring detailed fetal anatomical evaluation;

• History of birth with congenital, genetic or chromosomal abnormalities
• Known or suspected fetal anomaly or growth restriction in an existing pregnancy

Conditions that increase the risk of congenital anomalies in the fetus:

• Presence of diabetes in the mother diagnosed before pregnancy or before the 24th week of pregnancy
• Conception with assisted reproductive technology (In Vitro Fertilization)
• High body mass index (≥35 kg/m2)
• multiple pregnancies
• Abnormal serum analyte level (alpha-fetoprotein and unconjugated estriol)
• Teratogen exposure
• Increased nuchal translucency (≥3 mm) in first trimester ultrasonography

Conditions that increase the risk of genetic or chromosomal anomalies in the fetus;

• Chromosomal or genetic disease carrier in the family
• Maternal age at birth ≥35
• Positivity of screening test for chromosome anomaly (first and second trimester tests)
• Presence of down syndrome markers on ultrasonography (brightness in the heart and intestines, etc.)
• Increased nuchal translucency (≥3 mm) in first trimester ultrasonography

Other conditions affecting the fetus:

• congenital infections
• Drug addiction in mother
• Blood incompatibility
• Oligohydramnios (lack of water)
• Polyhydramnios (excess water)

First Trimester Screening

The most commonly used first trimester screening protocol combines sonographic nuchal translucency with two maternal serum markers. The double screening test is performed between the 11th and 14th weeks.

Second Trimester Screening (Quadruple and Triple Test)

Quadruple Test

Ideally, it is performed between the 15th and 19th weeks. However, it can be done up to the 23rd week. The detection rate for Down syndrome is 75 – 80%, with 5% false positivity.

Triple Test

To determine the risk of Down syndrome, AFP, free or total hCG and uE3 levels are measured in the maternal blood between the 15th and 23rd weeks of pregnancy (ideally between the 15th and 19th weeks). The detection rate for Down syndrome is 60 – 70%, with 5% false positivity.

Free Fetal DNA Test in the Womb

It is a test that detects the DNA fragments of the baby circulating in the womb in a blood sample taken from the mother’s arm and determines the risk of some chromosomal diseases such as Down syndrome in the baby. It can be performed throughout the mother’s pregnancy, starting from the 9th week of pregnancy.