A biophysical profile is a simple, painless procedure to listen to the baby’s heartbeat using a fetal monitor. This test is performed to check for the well-being of your baby, and is commonly recommended for diabetes, high blood pressure, small baby/baby not growing properly, being past your due date or having too much or too little fluid around the baby. We will observe the baby’s heartbeat while the baby is resting and while the baby is moving and use an ultrasound machine to look at your baby’s movement, amniotic fluid and breathing motion. It typically takes about 30 to 70 minutes to complete the biophysical profile.

Mothers and babies who need special medical care and extra attention may need a nonstress test (NST). Some common reasons for an NST include diabetes, high blood pressure, small baby or baby not growing properly, baby being less active or being past your due date. An NST is a simple, painless procedure used to listen to and record the baby’s heartbeat while the baby is resting and while the baby is moving. It usually takes 20 to 40 minutes to complete an NST.

Amniocentesis is a procedure that may be performed in the second or third trimester of pregnancy to test for certain genetic abnormalities in a developing fetus. Women usually meet with a genetic counselor before having an amniocentesis.

Your doctor may recommend an amniocentesis because of advanced maternal age (e.g., 35 or older), your family history, or because other prenatal screenings may have revealed a risk that the baby may have an inherited or congenital condition. Amniocentesis can also be used to test the amniotic fluid for signs of fetal infection or for a fetal protein known as alpha-fetoprotein, or AFP. AFP is used when checking for spina bifida (open spine defects).

Combined first-trimester nuchal translucency screening is a noninvasive screening test for fetal Down syndrome and trisomies 13 and 18. Prenatal genetic counseling services are also provided in conjunction with first-trimester screening, if requested.

If you are a health care provider referring your patient to Johns Hopkins for first-trimester screening, learn more here.

Chorionic villus sampling (CVS) is a procedure done early in pregnancy to test for certain genetic abnormalities in a developing fetus. Women usually undergo genetic counseling before having CVS.

Your doctor may recommend CVS because of advanced maternal age (e.g., 35 or older), your family history, or because other prenatal screenings may have revealed a risk that the baby may have an inherited or congenital condition.

The Doppler test measures blood flow in different parts of your uterus or baby’s body, including the umbilical cord, brain, liver and heart. This allows your physician to get information about your baby’s health. A Doppler may be performed when there is a known or suspected abnormality or condition that may alter the blood flow in the fetal or placental circulation, such as intrauterine growth restriction, fetal cardiac abnormalities and maternal conditions, like chronic hypertension. Usually, this test is performed at the same time as an ultrasound and uses the same equipment.

Fetal echocardiography is a specialized ultrasound study that focuses on the fetal heart. We look at the structure of and blood flow through the fetal heart and the fetal cardiac rhythm. Most fetal echocardiography studies are performed greater than or equal to 20 weeks of gestation for specific indications. Early fetal echocardiography may be performed between 11 to 16 weeks, and in such cases, a complete fetal echocardiogram follow-up will be recommended again at greater than or equal to 20 weeks of gestation.

Fetal echocardiography might be performed to detect:

• Previous child born with a congenital heart defect
• Other family history of heart problems
• Maternal diabetes
• Fetal arrhythmia (abnormal cardiac rhythm)
• Positive maternal SS-A and/or SS-B antibodies
• Medication or teratogen exposure
• Fetus with noncardiac abnormalities
• Fetus with a chromosomal abnormality
• Abnormal screening ultrasound
• Maternal PKU
• IVF pregnancy
• Monochorionic twins

The Johns Hopkins Division of Maternal-Fetal Medicine provides a wide range of ultrasound services with state-of-the-art machines, including those with 3D and 4D capabilities, for first-trimester scans, comprehensive fetal anatomy screens, fetal growth scans, multiple gestations and second opinion/consultation for known/suspected fetal abnormalities. In addition, we offer fetal echocardiography, combined first-trimester nuchal translucency screening and ultrasound guidance for invasive fetal procedures.

Visit our genetic counseling page for full details on genetic counseling services and our team.

Genetic counseling is appropriate for a variety of needs including women above the age of 33, people that have received abnormal screening test results, couples with a history of genetic conditions, couples experiencing infertility and more. Counselors can help provide you with information on risks or concerns associated with abnormalities, assist you with considering factors involved with carrier screening or prenatal testing, provide you with educational resources and help direct you to the correct specialists for care as needed.

For more information or to schedule an appointment, visit our website or call 410-955-3091.

The primary goal of genetic counseling is to provide information and support for your decisions regarding genetic testing in your pregnancy.

Results from genetic testing will be communicated to you and your obstetric care provider by the genetic counselors. In most pregnancies, testing results are normal and reassuring to the family. If a fetal abnormality is detected, the counselor will provide additional information and referrals to specialists.

Read more about what to expect on our genetic counseling website.

Genetic counselors have a master’s degree in genetic counseling and are certified by the American Board of Genetic Counseling.

If you elect to proceed with testing, your genetic counselor will coordinate those studies and report the results to you and your physician. Reproductive options for future pregnancies will also be reviewed.

Read more about what to expect on our genetic counseling website.

The David A. Nagey Perinatal Outreach Program at Johns Hopkins Medicine provides:

• 24/7 telephone consultation services with Johns Hopkins perinatologists
• Maternal transport services, either by ambulance or air
• Specialized and comprehensive high-risk obstetrical services, including:

• HIV in pregnancy
  410-614-3023
• Genetic counseling
  410-955-3091
• Diabetes in pregnancy
  Managed by maternal-fetal medicine specialist or high-risk obstetrician referral
• Obstetric ultrasound
  410-955-8976

Methods of Transportation:

• Ambulance. Ground transportation can be arranged by the referring hospital through its local ambulance services.
• Air. The Johns Hopkins Lifeline transport system will provide either air or ground transportation. Arrangements can be made via the HAL line at 410-955-9444.

Perinatology consultations and/or maternal transports can be arranged by calling any of the following:

• Hopkins Access Line (HAL Line)
  410-955-9444 OR
  1-800-765-JHHS (5447)
• Johns Hopkins Birthing Center (Labor and Delivery)
  410-955-5850
  1-888-JHH-MOMS (544-6667)

The Division of Neonatal-Perinatal Medicine (Neonatology) provides comprehensive care for premature and high-risk babies, offering a complete range of medical and surgical services to its small patients.

Supported by a wide range of pediatric specialty consultants, care is delivered by a dedicated staff of neonatal nurses in collaboration with subspecialty-trained neonatologists in our newborn intensive care unit (NICU).

Johns Hopkins Hospital's 45-bed NICU provides care to the East Baltimore population and serves as a major east coast referral center. In addition to providing state-of-the-art medical technologies, including the various modes of mechanical ventilation, diagnostic evaluation and treatments, every attempt is made to deliver care in a manner that fosters optimal development of the newborn infant as well as incorporates the family into care plan initiatives.

View more about each of our NICUs by hospital:

• Johns Hopkins Hospital
• Johns Hopkins Bayview Medical Center
• Sibley Memorial Hospital
• Johns Hopkins Howard County Medical Center