Kofinas Perinatal: Maternal-Fetal Medicine High Risk Pregnancy
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Frequently Asked Questions

As a physician practicing for over 20 years, I have encountered countless questions and have heard infinite concerns from mothers and their families about everything from smoking during pregnancy to what sort of music may or may not be harmful to the development of a baby’s ears. Hopefully, going through this list will ease some of your worries, or in the least inform you as to what you should and should not be concerned about. - Alexander D. Kofinas, MD

» Premature Labor

» Incompetent Cervix

» Pregnancy Loss

» Nutrition & Exercise

» Thrombophilia

» Fetal Monitoring

» Meds and Supplements

» Cerebral Palsy

» Medical Conditions

» Miscellaneous



Is there any way to detect fetal brain sparing during my pregnancy?
Brain sparing can be identified by DopplerDoppler:
Often used as a non-invasive method of measuring blood flow in humans.
  assessment of various fetal vessels. The great value of this assessment lies within the premise that it can identify a fetus at risk for brain damage when the fetus is still healthy. No other test has ever been so reliable in our opinion. In contrast, fetal electronic monitoring (NST) has never been shown to prevent such damage reliably, and when such a test returns as abnormal, the risk for having already sustained some degree of fetal brain damage is almost 40%. At KOFINAS PERINATAL, fetal cardiovascular assessment by means of advanced DopplerDoppler:
Often used as a non-invasive method of measuring blood flow in humans.
  technologies is the primary means of assessing fetal well-being, along with a fetal Biophysical ProfileBiophysical Profile:
An ultrasound test which evaluates fetal behavior (breathing, tone, movement)and amniotic fluid volume.
  (assessment of fetal behavior by use of real-time ultrasound).
What causes cerebral palsy?

Cerebral palsy can occur for several reasons and a number of conditions have been associated with it. Although prematurity is often associated with cerebral palsy, most of the babies that suffer from it are born at term. Often times it is a lack of oxygen to the NeonateNeonate:
A newborn infant, especially one less than four weeks old.
 , leading to AsphyxiaAsphyxia:
A condition in which an extreme decrease in the amount of oxygen in the body accompanied by an increase of carbon dioxide leads to loss of consciousness or death.
  and brain damage, which may induce cerebral palsy. This is one reason why prematurity is often associated with cerebral palsy, since such babies are more likely to receive inadequate oxygen supplies (before, during and after birth). The presence of inflammatory markers (chemicals) in AmnioticAmniotic:
Of or related to the amnion or characterized by developing an amnion; "amniotic membrane"
  fluid and in fetal cord blood has also been associated with cerebral palsy, leading many researchers to believe that infection is one of the causes of cerebral palsy. This however, may be incorrect since many of the inflammatory markers that researchers attributed to the presence of infection were the result of non-infectious inflammatory placental reactions. In a study of NeonateNeonate:
A newborn infant, especially one less than four weeks old.
  with cerebral palsy, it was found that 80% of the placentas exhibited various levels of ThrombosisThrombosis:
Formation or presence of a thrombus; clotting within a blood vessel which may cause infarction of tissues supplied by the vessel.
  (clot formation) and chorionic tissue necrosis. It is our opinion that in most cerebral palsy cases it is some variation of placental failure, which is the culprit. Conditions such as growth failure (IntrauterineIntrauterine:
Occurring or situated within the uterus.
  fetal growth retardation), PretermPreterm:
Occuring or appearing before the expected time at the end of a full-term pregnancy.
  labor, placental ThrombosisThrombosis:
Formation or presence of a thrombus; clotting within a blood vessel which may cause infarction of tissues supplied by the vessel.
 , fetal vessel ThrombosisThrombosis:
Formation or presence of a thrombus; clotting within a blood vessel which may cause infarction of tissues supplied by the vessel.
 , PlacentaPlacenta:
A membranous vascular organ that develops in female mammals during pregnancy, lining the uterine wall and partially enveloping the fetus.
  abruptio and PreeclampsiaPreeclampsia:
A condition of hypertension occurring in pregnancy, typically accompanied by edema and proteinuria.
  are all linked to an increased risk for cerebral palsy. Such complications are often the result of poor placental development.

What is brain sparing?
Brain sparing is a PhysiologicalPhysiological:
Being in accord with or characteristic of the normal functioning of a living organism.
  mechanism used by the fetus to increase delivery of oxygenated blood to the brain at the expense of other organs. Unlike fully formed adults, only three organs are of importance to the fetus: the brain, the heart, and the adrenals (glands which produce AdrenalineAdrenaline:
A hormone secreted by the adrenal medulla that is released into the bloodstream in response to physical or mental stress. Can lead to increased blood pressure and heart action.
  and natural steroids). When a fetus senses that the amount of oxygen in its blood is decreasing it makes an effort to protect its three most vital organs at the expense of all others, such as the liver, kidneys, muscles etc. This is achieved by a sophisticated cardiovascular response, which diverts more well-oxygenated blood to the important organs. This mechanism can protect the baby for up to 3 weeks.
What is cerebral palsy?
Cerebral palsy, also known as spastic paralysis, is defined as a non-progressive motor deficit of early onset. This may occur in one or more limbs with paralysis, spasticity or problems of motor control representing some of the symptoms. Cerebral palsy is usually the result of brain damage caused by a lack of oxygen. Reasons for oxygen deficiency may vary but are often the result of poor placental function. Cerebral palsy affects 1 in 500 – 1000 NeonateNeonate:
A newborn infant, especially one less than four weeks old.
  and its incidence has not decreased despite the millions spent annually for its prevention.
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