Defining the relationship between obstetricians and maternal-fetal medicine specialists

OBJECTIVE: The purpose of this study was to determine how frequently genera l obstetricians refer pregnant patients to maternal-fetal medicine speciali sts in the presence of the clinical Indications specified as appropriate fo r referral or consultation by the 1996 statement of the Society of Perinata l Obstetricians. STUDY DESIGN: A questionnaire was mailed to 400 randomly selected general o bstetricians across the United States. The obstetricians were asked how oft en they refer their high-risk pregnant patients to maternal-fetal medicine specialists in the presence of (1) a need for diagnostic or therapeutic pro cedures, (2) medical/surgical disorders, (3) healthy gravid women with high -risk fetuses, and (4) conditions that necessitate admission for reasons ot her than delivery. Response categories for each individual procedure/high-r isk condition included "always," "frequently," "infrequently," "never," and "not applicable." RESULTS: Overall, 55% of the responses indicated referral (always or freque ntly) to maternal-fetal medicine specialists for procedures or in the prese nce of high-risk conditions. More than 75% of the obstetricians always or f requently refer to maternal-fetal medicine specialists for most diagnostic/ therapeutic procedures and for the following high-risk conditions: acute fa tty liver, portal hypertension, pulmonary hypertension, transplantations, f etal hydrops, fetal anomaly/cytogenetic abnormality, fetal supraventricular tachycardia or congenital heart block, isoimmunization, and twin-to-twin t ransfusion syndrome.' CONCLUSION: Most of the conditions for which > 75% of the obstetricians ref er to maternal-fetal medicine are rarely seen in practice. Comprehensive ul trasound examination is the only commonly encountered clinical situation th at > 75% of the general obstetricians refer to maternal-fetal medicine spec ialists.