Maternal-Fetal Medicine (also known as high risk pregnancy) is a sub-specialty within Obstetrics and Gynecology that involves pregnancies at risk for complications (see statement by the Society of Maternal Fetal Medicine SMFM).
According to the SMFM, the discipline of Maternal-Fetal Medicine involves the following conditions and patients:

Obstetric complications

  • Recurrent pregnancy loss
  • Preterm birth prevention
  • Asymptomatic (eg, prior second-trimester loss, possible cervical insufficiency)
  • Prior preterm birth 
  • Mullerian abnormalities
  • Short cervical length
  • Cervical cerclage
  • pessary, progesterone, or other interventions for prevention of PTB
  • Symptomatic preterm labor
  • Preterm premature rupture of fetal membranes (PPROM)
  • Meconium complications
  • Malpresentation and malposition
  • Shoulder dystocia
  • Abnormal third stage of labor
  • Placenta accreta, increta, percreta
  • Second- or third-trimester vaginal bleeding
  • Preeclampsia with severe elements/eclampsia with HELLP syndrome or end-organ damage
  • Severe postpartum hemorrhage
  • Cesarean hysterectomy
  • Acute fatty liver of pregnancy
  • Amniotic fluid embolism

MATERNAL COMPLICATIONS

Hypertensive disorders

  • Chronic hypertension
  • Preeclampsia
  • Severe Preeclampsia
  • HELLP syndrome

Cardiac disease
  • Congenital heart disease
  • Arrhythmias
  • Valve disease
  • Cardiomyopathy
  • Pulmonary hypertension
  • Coronary artery disease
  • Heart transplant
  • Cardiac disease (Clark's Group II, III, any valve replacement)
Any antepartum patient admitted for "other than delivery" and patients with postpartum complications 
such as
  • severe hemorrhage, 
  • refractory infections, 
  • complicated preeclampsia, 
  • eclampsia and 
  • difficult post cesarean complications
  • Eating disorders
 
  • Severe preeclampsia/eclampsia HELLP syndrome
  • Substance abuse
  • Transplants
Respiratory disease
  • Asthma
  • Pneumonia
  • Restrictive lung disease
  • Pulmonary edema
  • Influenza
  • Tuberculosis
  • Cystic fibrosis
Obesity

 

Endocrinologic disorders
  • Addison disease
  • Diabetes, insulin-requiring/dependent
  • Thyroid disease
  • Parathyroid disease
  • Pheochromocytoma
Gastrointestinal disease
  • Nausea and vomiting in pregnancy; hyperemesis gravidarum
  • Eating disorders
  • Intrahepatic cholestasis
  • Inflammatory bowel disease (ulcerative colitis; Crohn’s disease)
  • Gallbladder disease (cholecystitis, cholelithiasis)
  • Pregnancy after liver transplantation
  • Pancreatitis
  • Wilson disease
  • Hepatitis
  • Acute fatty liver of pregnancy
  • Portal hypertension
  • Ulcerative colitis
  • Crohn's disease
Hematologic diseases
  • Maternal anemia and hemoglobinopathies
  • Sickle cell disease
  • von Willebrand disease
  • Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome
  • Allo- and autoimmune thrombocytopenia
  • Thromboembolic disease, past or current
  • Care of the Jehovah’s Witness pregnant woman
  • SLE/Other collagen vascular disease
Congenital disorders with potential untoward maternal outcomes:
  • Cystic fibrosis
  • Marfan's syndrome
  • Protein S, C, AT-III deficiency
  • Factor 5 Leiden
  • Prothrombin mutation
Renal disease (includes renal transplantation)

 

Neurologic diseases:
  • Seizure disorders
  • Headache
  • Multiple sclerosis
  • AV malformation
  • Berry aneurysm
  • Prolactinoma
  • Pseudotumor cerebri
  • Myasthenia gravis
  • Paraplegia/quadriplegia
  • Spinal cord injury
  • Diabetes insipidus
Psychosocial issues and abuse
  • Smoking
  • Alcohol abuse
  • Drug abuse
  • Depression
  • Other psychiatric disorders
  • Domestic violence
Rheumatologic disorders
  • Antiphospholipid syndrome
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Other autoimmune disease
Thromboembolic disorders
  • Venous thromboembolism and anticoagulation
  • Inherited thrombophilia
Infectious disorders
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Cytomegalovirus (CMV)
  • Toxoplasmosis
  • Rubella
  • Parvovirus
  • Varicella
  • Herpes
  • Coccidomycosis
  • Listeria
  • HIV
  • Gonorrhea
  • Chlamydia
  • Syphilis
  • Trichomonas
  • Group B streptococcus
  • Vaccination concerns
  • Pyelonephritis
  • Management of wound infection
  • Other life-threatening infections
Trauma and critical care
  • Trauma
  • Critical care
  • Nonobstetric abdominal surgery in the current pregnancy

Skeletal; connective tissue
  • Marfan syndrome
  • Maternal skeletal dysplasia
Skin Conditions/Dermatoses

 

Fetal anomalies
  • Structural abnormalities
  • Family history of abnormality
  • Aneuploidy or increased risk for aneuploidy
  • Teratogen exposure

Fetal complications
  • Threatened miscarriage (including medical and surgical management)
  • Multifetal pregnancies (including, but not limited to, mono/di twins, mono/mono
  • twins, higher-order multiples; fetal growth restriction of 1 fetus; twin-twin transfusion
  • syndrome; fetal reduction)
  • Growth disorders
  • Growth restriction
  • Macrosomia
  • Infections (eg, cytomegalovirus, toxoplasmosis, parvovirus, Herpes, varicella)
  • Fetal death
  • Hemolytic disease (red cell alloimmunization)
  • Neonatal alloimmune thrombocytopenia
  • Nonimmune hydrops
  • Immune hydrops
Pregnant women with fetuses at markedly increased risk of adverse outcome, such as:
  • Abdominal pregnancy
  • Abnormal maternal serum testing
  • Fetal hydrops; immune, nonimmune
  • Fetal anomaly or cytogenetic abnormality
  • Fetal supraventricular tachycardia or congenital heart block
  • Incompetent cervix
  • Red cell alloimmunization
  • Mullerian abnormalities
  • Multifetal pregnancies (Twins, Triplets, etc)
  • Recurrent prior to preterm deliveries
  • Nonobstetric abdominal surgery in the current pregnancy
  • Oligohydramnios at <37 weeks gestation
  • Placenta accreta, increta, percreta
  • Polyhydramnios
  • Premature rupture of membranes <34 weeks gestation
  • Preterm labor <34 weeks gestation
  • Prior second trimester fetal loss
  • Prior intrauterine fetal demise
  • Recurrent pregnancy loss
  • Significant 2nd or 3rd trimester bleeding
  • Suspected intrauterine growth restriction
  • Twin-to-twin transfusion syndrome
Patients undergoing diagnostic or therapeutic procedures, including:
  • Abdominal cerclage
  • Chorionic villus sampling
  • Comprehensive ultrasound
  • Fetal gene therapy
  • Fetal blood sampling
  • Fetal transfusion
  • Fetal muscle/organ biopsy
  • Fetal reduction
  • Fetal skin sampling
  • Fetoscopy/embryoscopy
  • Genetic amniocentesis
  • Other diagnostic/therapeutic procedures
Fetal testing


Antepartum fetal monitoring

Sonographic assessment of amniotic fluid abnormalities
  • Oligohydramnios
  • Hydramnios
  • Fetal blood sampling/intrauterine transfusion
  • Screening for fetal anemia
  • Fetal muscle/organ biopsy
  • Fetal skin sampling
  • Fetal surgery; fetoscopy/embryoscopy
Maternal malignant disease
  • Cancer of the Ovary
  • Cancer of the Cervix
  • Cancer of the Endometrium
  • Fallopian Tube Cancer
  • Breast Cancer
  • Other Cancer