Frequently Asked Questions About Maternal-Fetal Medicine
During your appointment, we will discuss your medical condition, medications and history. This assessment may include evaluating your family and pregnancy history to determine whether genetic testing is recommended. The assessment may also include evaluation of and treatment for maternal diseases.
When a physician or nurse midwife has referred a family, parents often have many questions. We meet with each family to discuss these issues in great detail. The frequently asked questions below are designed to help answer your questions. Should you have further questions, please call our office at (541) 349-7600.
- What is The Center For Genetics and Maternal Fetal Medicine?
The Center for Genetics and Maternal-Fetal Medicine is the perinatology office within Women’s Care that specializes in obstetrics. We focus on managing health concerns of the mother and fetus prior to, during and shortly after pregnancy. We generally work as a consultant to your primary OBGYN provider. We provide care for Eugene/Springfield as well as a large portion of central Oregon. We currently have outreach clinics in Bend, Corvallis and Coos Bay.
We often see patients for indications such as:
- Advanced maternal age (over the age of 35 at delivery)
- Diabetes (Gestational Diabetes, Type I and Type II)
- Recurrent miscarriages
- Multiples in pregnancy (twins, triplets, etc)
- Complications during pregnancy
- What is genetic counseling?
Genetic counseling is a process by which a specialist works with women and their families who have a significant medical and/or pregnancy history of birth defects or genetic conditions. This process involves reviewing family, medical and pregnancy histories. We are then able to help give you information to help facilitate your decisions about reproductive options and preventative strategies.
Specialists will discuss pregnancy screening for common chromosomal abnormalities and common inherited genetic conditions (Carrier Screening). The available tests are discussed in detail, including the benefits, the limitations and the potential risk of all procedures. If it is helpful, we also recommend support groups and assist in referring to other specialists.
- What is prenatal diagnosis?
Prenatal diagnosis is the process of detecting certain types of birth defects and inherited disorders before a baby is born.
- What are birth defects?
Birth defects are abnormalities in a baby that may produce intellectual or physical problems after the baby is born. These problems can be mild, moderate or severe.
Babies with birth defects may have minimal problems, or they may be intellectually delayed, physically handicapped or otherwise disabled. The purpose of screening is to provide the parents with information to prepare for the potential issues.
- Who should consider reproductive genetic counseling and/or prenatal diagnosis?
- Women who are over age 35
- Women who have had a positive maternal serum screening test
- Women who have had an abnormal finding on a previous ultrasound
- Parents who have had a child with a chromosome abnormality such as Down syndrome, a birth defect such as spina bifida or a heart defect
- Parents who have a family history of a genetic condition such as some forms of intellectual delay, cystic fibrosis, sickle cell anemia, muscular dystrophy, Tay-Sachs or other rare conditions
- Women/couples known to be carriers for a genetic mutation or chromosome rearrangement
- Couples with a history of multiple pregnancy losses
- In certain situations, women with exposures to medications, drugs, infections or women with certain chronic illnesses.
Historically, prenatal diagnosis for Down syndrome and other chromosome abnormalities has been offered to women 35 years of age or older. With multiple screening methods now available, women of all ages have many options for screening and prenatal diagnosis.
- What tests are included in prenatal diagnosis?
- Ultrasound: This test uses sound waves (not radiation) to create a picture of the unborn baby on a special screen. It provides useful information about the unborn baby such as size, position, presence of twins (or more) and the presence of some physical defects. Ultrasound screening has been done on millions of pregnant women without any known harm to the mother or the baby.
- Nuchal Translucency Ultrasound: This measurement of the fluid in the back of the fetal neck is used to screen for chromosomal abnormalities like Down syndrome. The Nuchal Translucency Quality Review certifies all of the sonographers and physicians at CFGMFM.
- Detailed Anatomy or Level 2 Ultrasound: In the second trimester, we obtain a detailed view of the internal organ systems of your baby, as well as measurements. This provides information about your baby’s development. The detailed protocol we follow is approved by the American Institute of Ultrasound in Medicine.
- Fetal Echocardiogram: A highly specialized ultrasound evaluation of the baby’s heart by a technician with advanced training.
- Screening Tests: These tests are used to obtain an educated guess as to whether or not a baby has a specific condition. Some women will receive an increased risk and some women will receive a decreased risk. In other words, screening tests do not determine exactly which babies do or do not have the condition. A screening test narrows down the number of pregnancies that need more extensive testing (see below).
- Diagnostic Tests: These are invasive tests to evaluate the fetal or placental chromosomes.
- When can these tests be performed?
- Ultrasound: Anytime during pregnancy.
- First Trimester Screening: Between 11 and 13 weeks (ideally at 12 weeks); accompanied by ultrasound measurements.
- Second Trimester Screening: Between 15 and 20 weeks; accompanied by ultrasound measurements.
- NIPT (placental-fetal DNA) Screening: Anytime after 10 weeks.
- Chorionic Villi Sampling (CVS): Between 10 and 13 weeks.
- Routine Amniocentesis: Most commonly between 16 and 20 weeks.
- What blood screening tests are available?
We do NOT endorse any specific lab. Screening is OPTIONAL and is an individual choice
1. Screening for spontaneous chromosomal abnormalities (extra 21, 18 and 13)
a. Biochemical screening:
i. Sequential screening: Contact your insurance for coverage details. Most do cover.
ii. NTD Laboratories screening with pre-eclampsia risk: $360 cash price (with no coverage) $125 with prompt-pay.
iii. Quad marker
b. Non-Invasive Prenatal Screening (NIPS): This blood test examines fetal DNA from the placenta. It is used for women at increased risk for the more common chromosome problems such as Down syndrome (Trisomy 21), Trisomy 18 and Trisomy 13. It can also be used as a precursor, but it is not a substitute for, diagnostic testing such as CVS or amniocentesis. NIPS is not used for women at risk for rare chromosomal problems. Results return in 10 days. Usually not covered by insurance if there is no indication. This does test for gender. There are several companies we use for this test.
i. Natera: Will NOT get a price estimate before the test is run. $200 – $349 cash price (with no coverage). Pricing questions: (360) 608-1727
ii. Counsyl: Will get price estimate before test is run. They will send you an e-mail. Can cancel free of charge. $349 cash price (with no coverage). Pricing question: (888) 268-6795
2. Inherited Genetic Carrier Screening: There are panel tests that can screen a healthy adult to see if he or she carries a silent mutation. The risk to children occurs when each parent is a carrier of the same condition. Examples of these types of conditions include cystic fibrosis, spinal muscular atrophy, Fragile X and hemoglobinopathies. Pan-ethnic carrier screening for as many as 176 conditions is available at NO extra price.
Results return in 14 days
*Billing prices and contact information for specific labs provided above, current as of 12/2018
- How is billing for genetic testing handled?
Outside labs perform genetic testing and we do not bill directly for those. Some insurance companies require that prior authorization is done before testing. If it is required, either the lab or our office will initiate the prior authorization process.
We are not able to obtain the prior authorization or give a cost estimate of your testing options before your appointment. We need to discuss your health and family history, review the ultrasound and discuss which of the multiple testing options and multiple lab companies have the appropriate tests for you.
You can also choose to perform the testing at a later date if you wish to see how your insurance company covers it. If you have an issue with your bill for genetic testing, please call the lab directly (see above). If you still have issues, please call our office for further assistance.
You can call your insurance provider to see if a prior authorization (PA) is required. These are the first trimester codes for when you call.
Common ICD-10 codes
- O09.511 Over 35 at delivery (1st pregnancy)
- O09.521 Over 35 at delivery (not first pregnancy)
- Z36.89 Under 35 at delivery
Common CPT codes
- 99203 Office Visit/moderate
- 76801 Diagnostic scan under 14 weeks
- 76813 First trimester nuchal translucency
- What diagnostic tests are available?
- Chorionic Villi Sampling (CVS): The fetus and the placenta are located with ultrasound. Then a catheter is inserted through the woman’s vagina and cervix, or a thin needle is inserted through the woman’s abdomen to obtain a sample of the placenta so the fetal chromosomes can be examined. We refer patients to Portland for CVS.
- Amniocentesis: After locating a safe area by ultrasound, a thin needle is inserted through the woman’s abdomen into the uterus and a small amount of the fluid around the fetus is taken out. The fluid and the cells in the fluid are sent to a laboratory for analysis. The type of testing will be discussed and is usually a karyotype or a microarray.
- Do you perform paternity testing?
This test is not performed in the state of Oregon.
To facilitate this testing you can call DNA Diagnostics at 1-800-362-2368. The website is DNAcenter.com.
- Do you test for the gender of the baby?
We do not test solely for the gender of the baby. However, if a test is medically necessary, some of the tests performed will include the gender of the fetus. Our providers will discuss this option during your appointment.
- How quickly will my appointment be scheduled?
We understand that there can be anxiety with getting scheduled. We ask that you please do not call our office before the time frames below, as we need to obtain your records, discuss them with the doctor and evaluate when we can get you scheduled.
Routine: Your primary OBGYN will send a referral to our office. We will call within 48 hours to schedule.
Emergent: Your provider will call and speak to our doctor, then we will call as soon as possible.
- What should I bring for my appointment?
Bring a copy of your insurance card, your identification and any filled-out paperwork that you received in the mail.
We receive records from your referring office; however, if you have records that you feel would be beneficial for your appointment, please bring them with you to your appointment. This could include your family members’ records as well.
If you need assistance in gathering records, please call our office to discuss.
Please note, a release of information form is needed for medical records requests.
- Will there be an ultrasound at my appointment?
Yes, we will schedule your appointment with an ultrasound with the exception of our preconception appointments and some of our follow-up appointments.
Please dress comfortably. If you are before 14 weeks in gestational age, please try to have a moderately full bladder as it helps our staff obtain better views. It is usually ok to void up to 30 minutes prior to your appointment. There is no need to drink extra fluids prior to your appointment. There are no special requirements for an ultrasound if you are 14 weeks or greater in gestational age.
- What is a transvaginal ultrasound?
A transvaginal ultrasound is a technique used to image the female reproductive organs and surrounding pelvic structures. This includes your cervix, uterus, ovaries and the fetus. The transducer is placed inside the vagina to attempt better visualization of these structures or the fetus. There is no special preparation for the transvaginal ultrasound. Although a transvaginal ultrasound is not performed at every appointment, it may be necessary to provide the physician with more information on the baby, your cervix or the placental location.
- Do you perform 3D and 4D ultrasounds?
Yes, we do perform 3D and 4D ultrasounds; however, they are mostly performed when medically necessary. The ability to obtain these images depends on the position of the baby and the amount of amniotic fluid.
- What do I do if I did not receive my ultrasound photos?
You will receive a link to the recognizable pictures taken during your ultrasound through Tricefy.
If you do not receive your pictures, please e-mail firstname.lastname@example.org
- I got several pictures of my ultrasound during my visit. How do I get a copy of all of my ultrasound images?
MFM can send all images by email. There is a $35 fee to process this request.
Please allow one week at least for this request to be completed since it does take time to compile all of the images. To initiate the request, fill out a Release of Information form and send it to our office by mail, fax or drop off at our office. Include “All ultrasound images” for the records being requested. We will call to confirm the request was received and confirm the fee amount. Our medical staff will process the request.
- How long do typical appointments last?
Depending on your needs, your appointment will last 1 – 2 ½ hours. If you are expecting multiples (twins or triplets), your appointments could be longer depending on your gestational age. This is to ensure the measurements, anatomy and other required elements can be performed for each baby during the ultrasound.
- May I bring guests to my appointment?
Our facility can accommodate up to three guests with you for your appointment. Children are welcome; however, they typically do not appreciate sitting in a dark room during the ultrasound. Please bring an adult that can take the children to the waiting room if they need a break.
- What is our location?
Center for Genetics and Maternal-Fetal Medicine
3355 Riverbend Drive Suite 210
Springfield, OR 97477
Our office is located on the Sacred Heart Riverbend Hospital Campus in Springfield, OR. We are in the Northwest Specialty Clinic Building on floor 2 in Suite 210.
Business Office Hours:
Mondays: 8:30 AM – 5:00 PM
Tuesday: 8:30 AM – 5:00 PM
Wednesday : 8:30 AM – 4:00 PM
Thursday: 8:30 AM – 5:00 PM
Friday: 8:30 AM – 5:00 PM
- Does your office refer to other offices?
Sometimes our providers will refer to other offices if they feel it would be beneficial for your care. They will discuss this referral with you before placing it. We have a referral coordinator that will assist with the process.
- What do I do if I have Gestational Diabetes (GD)
Your primary OBGYN will refer you to a dietitian and Maternal-Fetal Medicine. Please make an appointment with the dietitian first, as they will educate you about your diet and give you a glucometer to test your blood sugars.
Call our office once this visit is set and we will get you scheduled 3-4 days after your dietitian visit. We usually also schedule an ultrasound to check the growth of the baby and the amniotic fluid, since these can be affected by gestational diabetes.
You will still have your primary OBGYN for your main pregnancy care, and Maternal-Fetal Medicine will co-manage with your primary regarding your Gestational Diabetes throughout the pregnancy. You will be asked to send in your blood sugar logs to us weekly by e-mail, fax or by calling our office.
- How do I have your office send records to my referring office?
Our office sends records of your visit back to your referring provider once they are complete.
- How do I get access to records from your office personally or send them to another location?
If you wish for your records to be sent to another location or would like a copy for personal records, please fill out a Release of Information (ROI) form. We can mail, fax or securely email records. We also can have them prepared for pickup at our office.
When filling out the Release of Information form, please keep in mind to:
- INITIAL the documents you wish to release on the form.
- Be specific in what you wish to release. If you are looking for a certain document, please include it in the “Other” portion of the document.
- Provide the name, phone and fax/address for the location or person you want the documents to be sent to in the “Records Released To:” portion of the form.
- Sign the document; we cannot accept a typed signature.
- Mail or fax to: 3355 RiverBend Dr Suite 210 Springfield OR, 97477 Fax: (541) 686 -8330
- If I transfer care to a new provider during my current pregnancy, how do I have my records sent to my new provider?
- Fill out a Release of Information (ROI) form with the new provider’s information (i.e. fax, address or secure email address). Please state on the form that you are transferring care to this new provider so future visits will be sent to the correct location.
- Have your new provider send a fax request for records stating that you are transferring care to their location.
- When are records typically sent after a Release of Information form is received by your office?
We have 30 days to process a Release of Information form from the date our office receives the request. However, we typically process them much sooner. Turnaround depends on the volume of requests, the urgency of records and other business needs. If you have specific date records are needed by, please indicate the date and the reason for faster processing.