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Advanced Planning and Care Can Improve Outcomes for High-Risk Pregnancies

Medical advances and improved medical management have contributed to increasingly positive outcomes for high-risk mothers and their babies over the years.

"We have the ability to make the greatest impact when we see these women very early in their pregnancy so we can put the measures in place to control their complications," says Ramzy Nakad, MD, maternal-fetal medicine specialist at the Olson Center for Women's Health at the University of Nebraska Medical Center. "Ideally, we'd like to see these women before they become pregnant so we can provide preconceptual pregnancy planning."

Ramzy Nakad, MD

Dr. Nakad, who joined the clinic last year, is one of four maternal-fetal medicine specialists who practices at the Olson Center for Women's Health with specialized expertise in managing high-risk pregnancies. His partners include Carl Smith, MD, Teresa Berg, MD andPaul Tomich, MD.

Women considered to be at high risk include those who are at an advanced maternal age (35 years and older); those in their teens; women with pre-existing medical conditions; fetuses with conditions that could affect the outcome of the pregnancy; women who have had previous multiple births or C-sections; women with a history of preterm labor or premature rupture of the membranes; recurrent pregnancy loss and suspected fetal growth restriction.

Pre-existing medical conditions that need special attention include Type 1 or Type 2 diabetes; hypo or hyperthyroidism; autoimmune diseases; high blood pressure, preeclampsia and antiphospholipid anti-body syndrome.

"We work collaboratively with a patient's family physician or obstetrician to provide consultative support, or if desired, we can follow the patient throughout her pregnancy, delivery and post-partum care," says Dr. Nakad.

"Maternal-fetal medicine physicians have additional training and experience in caring for women with complicated pregnancies, which can make a big difference in achieving a positive outcome," says Dr. Nakad. This additional training includes three years of a maternal-fetal medicine fellowship in addition to four years of an obstetrics and gynecology residency.

Dr. Nakad says that genetic testing as well as advanced screening tools help them provide better prenatal diagnosis of fetuses with abnormalities and other potential problems early in the pregnancy. High resolution ultrasound provides information about the growth of the fetus, the rate of blood flow through the vessels, potential structural problems, as well as the function of organ systems within the fetus.

"With this information, we can put better care and preventive measures in place during pregnancy to minimize complications later," he says.

High-risk mothers and their babies also do better when they deliver at major medical centers that specialize in maternal and neonatal care such as Nebraska Medicine. Nebraska Medicine is one of just two hospitals in the city that also provides neonatal surgical support.

Nebraska Medicine's Neonatal Intensive Care Unit (NICU) offers a full range of acute care services to the mother and baby, including nitric oxide, high frequency oscillating ventilation (HFOV), neonatal transport and the only neonatal ECMO program in Nebraska.

"With preterm labor, there are many complications that can occur to both the baby and the mother," says Dr. Nakad. "We have the medical and surgical specialists who are trained and experienced at handling emergency complications and surgeries for both." This includes neonatologists, pediatric surgeons, pediatric cardiologists, pediatric neurologists and specialists in infectious disease, genetics and endocrine and metabolic disorders.

The Olson Center for Women's Health offers women comprehensive care and services for women in one clinic including primary care, OB/GYN care, breast care, digital mammography and imaging scanning, high risk pregnancy care, physical therapy, genetic counseling, infertility and more. Women have the comfort and convenience of receiving all of these services at one location.

For a referral or to contact the Olson Center for Women's Health, call 402-559-4500.