Perinatologist

What is a perinatologist?

A perinatologist is an obstetrician-gynecologist (OBGYN) who specializes in high-risk pregnancies. Perinatologists are also called maternal-fetal medicine (MFM) specialists or high-risk OBGYNs. They focus on pregnancies where the pregnant person or the fetus has a health complication. If you have a chronic medical condition, you may work with a perinatologist before or shortly after becoming pregnant. In some cases, a person develops a condition during pregnancy that requires extra monitoring or testing from a perinatologist. A perinatologist can also be involved in your prenatal care if the fetus has a congenital disorder or birth abnormality.

What does a perinatologist do?

A perinatologist is an expert in prenatal and postnatal care for people at higher risk of pregnancy, labor or delivery complications due to a health condition. They help treat preexisting conditions as well as conditions caused by pregnancy. Their expertise includes treating pregnant people and diagnosing and managing health conditions in fetuses. Perinatologists can offer more advanced testing for congenital disorders and provide information on how certain pregnancy conditions affect the fetus.

Perinatologists are responsible for:

• Preconception counseling for underlying health conditions that may lead to pregnancy complications.
• Routine prenatal care and testing for high-risk pregnancies.
• Managing preexisting or new health conditions in a pregnant person.
• Using ultrasounds or other tests to diagnose genetic disorders or birth abnormalities.
• Assisting in labor and delivery as needed.
• Managing postpartum complications.

What is considered a high-risk pregnancy?

If your pregnancy is high-risk, you may need extra care or attention to ensure your pregnancy and delivery are successful. Some of the most common causes of a high-risk pregnancy are:

• Advanced maternal age (particularly in people older than 40).
• Multiple gestations (pregnant with twins, triplets or more).
• Previous miscarriages or stillbirths.
• Family history of genetic disorders.
• History of pregnancy complications such as preeclampsia, preterm labor or gestational diabetes.
• You have a serious health condition like heart disease, diabetes, high blood pressure, inflammatory bowel disease or an autoimmune disorder.

Just because your pregnancy is high-risk doesn’t mean there’s a problem with the fetus or that your pregnancy is dangerous. It means you’ll get closer monitoring because there’s a slightly higher risk of a problem.

Why would I be referred to a perinatologist?

Your OBGYN may refer you to a perinatologist if your pregnancy is high-risk or the fetus is suspected of having a complex medical issue or congenital condition. Most OBGYNs can manage minor pregnancy complications such as well-managed high blood pressure or gestational diabetes. However, if the condition worsens or is beyond your regular OBGYN’s expertise, they’ll refer you to a maternal-fetal medicine specialist or perinatologist. OBGYNs often consult with a perinatologist to get a second opinion.

Some people see a perinatologist before conception occurs because they already know their pregnancy will be high-risk. In other cases, a health condition develops due to pregnancy or is unexpected.

Some reasons your OBGYN may send you to a perinatologist before or during pregnancy are:

• Preexisting conditions like a heart condition, lupus or diabetes.
• Severe high blood pressure or preeclampsia.
• Risk of pre-term labor.
• You have a history of heart disease, seizures or kidney problems.
• You’ve had multiple miscarriages or stillbirths.
• You had an abnormal prenatal screening test.
• You’re expecting multiples (twins, triplets or more).

A perinatologist may see you after giving birth if you experience excessive vaginal bleeding, develop an infection or if some other type of health complication arises.

What conditions or diseases does a perinatologist treat?

Perinatologists help treat chronic diseases in a pregnant person that could impact the pregnancy or the fetus. Some of those conditions are:

• Diabetes.
• High blood pressure.
• Bleeding and clotting disorders.
• Heart disease.
• Kidney disease.
• Autoimmune disease.
• Genetic disorders like cystic fibrosis or sickle cell disease.

You may also see a perinatologist if you’ve had prior high-risk or complicated pregnancies. Some examples of previous pregnancy complications are:

• Early labor or premature rupture of the membranes.
• Miscarriages or stillbirths.
• Fetal growth restriction.
• Congenital or genetic disorders.
• Placental disorders like placental abruption or placenta previa.

What's the difference between an obstetrician and a perinatologist?

A perinatologist is an obstetrician who specializes in high-risk pregnancies. They’ve completed two or three extra years of training to further specialize in complex medical and surgical complications of pregnancy. They can also diagnose and manage fetal conditions like genetic disorders.

Seeing a perinatologist doesn’t mean they become your primary obstetrician. It usually means your pregnancy care includes both an obstetrician and a perinatologist. Your obstetrician will determine how often you see a perinatologist. Sometimes a perinatologist is highly involved in pregnancy and delivery. Other times a pregnant person will see a perinatologist a few times during pregnancy.

What's the difference between maternal-fetal medicine and a perinatologist?

A maternal-fetal medicine specialist and a perinatologist are the same. The terms can be used interchangeably. Both are terms for physicians that handle high-risk pregnancies or complex medical conditions during pregnancy.

How long does it take to become a perinatologist?

Perinatology is a sub-specialty of obstetrics and gynecology. Perinatologists complete an undergraduate degree and then attend medical school. After completing a four-year residency training in obstetrics and gynecology, perinatologists complete an additional two- or three-year fellowship in perinatology. Perinatology fellowships focus on how to treat pregnancy complications and how diseases affect the pregnant person and the fetus.

What can I expect from my first visit to a perinatologist?

It depends on your condition and why you were referred to a perinatologist. In most cases, your first appointment will be used to collect your health history or go over details of your condition and how it impacts your pregnancy. Your perinatologist may counsel you on genetic or congenital conditions the fetus has and discuss the type of medical care it needs at birth. Sometimes a perinatologist will provide genetic testing, ultrasounds, fetal monitoring and other tests to diagnose a condition.

You can expect your perinatologist to work with your OBGYN and any other healthcare providers on your care team throughout your pregnancy and delivery. They may also work with a neonatologist or pediatrician.

What tests does a perinatologist perform?

Perinatologists perform various laboratory tests to diagnose genetic conditions and diseases during pregnancy. Some of these are:

• Ultrasound.
• Blood tests.
• Prenatal screening.
• Amniocentesis.
• Chorionic villus sampling (CVS).

Do perinatologists deliver babies?

Sometimes. It depends on the condition and the potential complications. In most cases, an obstetrician will deliver your baby.

Do perinatologists do surgeries?

Your obstetrician or gynecologist will still manage most of your care. They’ll consult with your perinatologist on your pregnancy, labor and delivery needs as they relate to your medical condition. In some cases, it could mean having a perinatologist in the delivery room.

Perinatologists often perform specialized surgeries including complicated C-sections, cervical cerclage and emergency hysterectomy.

A note from Cleveland Clinic

Perinatologists are experts in high-risk or complicated pregnancies. Being referred to a perinatologist may feel scary. It doesn’t mean something’s wrong with your pregnancy — it means your healthcare team is giving you the care you need to ensure you and the fetus are healthy. Talk to your OBGYN about any concerns you have, and don’t be afraid to ask your perinatologist questions about your condition or treatment.