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High-Risk Obstetrics and Maternal-Fetal Medicine

Pregnancy is a time of great expectations. Obstetricians and family physicians have the unique privilege of sharing in this special time by helping an expectant mother understand and cope with the physical changes she is undergoing. When a high risk situation or complication during pregnancy causes worry, an obstetrician wants to refer a patient to a facility where she will be confident and secure and where all of her needs will be met in a caring environment.

West Penn Allegheny Health System’s Program for High-Risk Obstetrics/ Maternal-Fetal Medicine combines the latest technology in high-risk obstetrical services with personalized care to help ensure the confidence of both the expectant mother and her physician.

Continuity of Care

We provide a unified, interdisciplinary approach to high-risk obstetrics. The program is coordinated by five perinatologists and integrates the expertise of West Penn Allegheny Health System Department of Obstetrics and Gynecology and Division of Neonatology. For issues related to genetics or genetic issues, a board-certified OB/GYN medical geneticist is available with a team of genetic counselors. Full service, advanced facilities for both mother and baby are located under the same roof, saving precious time in situations where every moment is critical.

The program provides personal attention and maximizes continuity of care. The same perinatal team remains with the patient throughout the pregnancy to help ensure that no development is overlooked. This increased attentiveness allows us to tailor the program to each patient's needs and to each referring obstetricians's capabilities and requirements.

Varying degrees of participation exist--a referred patient may need only one visit to the program for a test or consultation, or in some cases, a full transfer of care can take place. In every case, our perinatologists act primarily as coordinators of care, making sure that all of the necessary specialists are involved in a patient's care.

Overall, we take a flexible, consultative approach to high-risk care, keeping the referring physician involved in each stage of care. The program's physicians provide prompt feedback to a referring physician via telephone and fax. The referring physician is also provided with direct, 24-hour access to a perinatologist via telephone and pager so there is no gap in communication.

Perinatal Consultations

The perinatal staff is widely accessible for consultations to assess the risk factors involved in a patient's pregnancy. The following perinatal services are provided:

  • Consultations regarding management of a pregnancy complicated by maternal disease such as diabetes mellitus, hypertension, cardiac disease or renal disease
  • Consultations regarding previous pregnancy issues, including repeated losses, preterm delivery, severe intrauterine growth restriction and pre-eclampsia
  • Consultation or complete management related to abnormal fetal conditions
  • Referral and/or assistance in performing amniocentesis (genetic and pulmonary) and in managing isoimmunization
  • Advice regarding the timing and method of delivery

The perinatal staff is also available by telephone for consultations on complications that may develop during pregnancy.

Prenatal Genetics and Genetic Counseling

This program offers evaluation and counseling for couples who are pregnant or planning a pregnancy and have a family history of birth defects, genetic disorders, intrauterine exposures, multiple miscarriages, or advanced maternal age.  Professionally trained personnel assist individuals, couples, and families to understand genetic conditions or birth defects.

These professionals can also help in finding medical services and community aid for affected individuals and their families. Individuals and/or families who would benefit from genetic counseling include:

  • Parents of a child with a genetic disorder, birth defect or chromosome abnormality
  • Couples who have experienced repeated pregnancy loss
  • Women who have been exposed to medications, drugs, radiation or other environmental agents
  • Individuals with a family history of a birth defect, developmental delay or genetic condition
  • Couples with advanced maternal or paternal age
  • Members of certain ethnic groups at increased risk for genetic disorders (i.e. those of Eastern European Jewish, Italian, Greek, African-American or Caucasian descent) or a couple in which the partners are related to each other
  • Individuals interested in prenatal diagnosis including those with positive screening

The following services are also provided:

  • Amniocentesis (second trimester)
  • Chorionic villus sampling (first trimester)
  • Fetal ultrasound evaluation (basic and targeted)
  • Maternal serum screening and cytogenetic studies
  • DNA analysis
  • Fetal therapy or surgery
  • 1st trimester screening
  • 2nd trimester screening

WPAHS is staffed with physicians who are board-certified in obstetrics/gynecology and clinical genetics, as well as board-certified genetic counselors. Perinatogists (specialists in maternal-fetal medicine) are available to patients for consultation for general genetic issues and to provide guidance in cases of discovered birth defects. Timing and the route of delivery can be discussed and members of the neonatology staff can address neonatal issues.

Ultrasound Evaluations

Obstetrical ultrasounds are performed by a sonographer and reviewed by a perinatologist or a medical geneticist who can offer detailed explanations to the patient during the evaluation and provide prompt, accurate feedback to the referring physician. Any abnormal results which require immediate attention are reported by telephone to the patient's physician.

Ultrasound evaluations are provided for the assessment of possible fetal anomalies including evaluations for:

  • Elevated maternal serum alpha-fetoprotein (MSAFP) levels
  • Increased aneuploidy (chromosome abnormality) risk by multiple marker screening (MMS) or 1st trimester testing
  • Neural tube/CNS defects
  • Omphalocele/gastroschisis
  • Renal abnormalities
  • Cardiac defects

Our staff also uses ultrasound to evaluate concerns for abnormal fetal growth including intrauterine growth restriction and macrosomia. Ultrasound evaluates abnormalities of amniotic fluid volume such as polyhydramnios and oligohydramnios and ultrasound is also used with multiple gestations to answer questions of placentation, growth and concordance.

Locations for OB/GYN Ultrasound

Maternal-Fetal Medicine physicians
Ronald Thomas, M.D., Director, Division of Maternal-Fetal Medicine
Mark Caine, M.D., Director, Labor & Delivery
Jennifer Celebrezze, M.D.
Ashi Daftary, M.D.
Steven Golde, M.D.
Kimberly Comport, R.N., M.S.N., C.N.S.

Reproductive Geneticist
Christann Jackson, M.D., Reproductive Geneticist

3D and 4D Ultrasounds

We receive many inquiries regarding 3D and 4D ultrasounds of unborn babies. We perform ultrasound studies only as a diagnostic study ordered by a physician. We adhere to the guidelines of many national medical organizations including the American Institute of Ultrasound in Medicine. We do not perform examinations for keepsake or entertainment purposes. If we are able to obtain 3D pictures in the course of the examination, we are happy to provide them for our patients at no additional charge.

Fetal Testing

The program offers a full range of fetal testing, including the following:

  • Non-stress tests
  • Biophysical profiles
  • Amniotic fluid indices
  • Doppler flow assessments

Communication of results to the referring physician is immediate, via telephone or fax.

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