17 - Maternal Fetal Medicine (Dr. Stephen Pedron)

This week’s guest, Dr. Stephen Pedron, joins Dr. Arnold to talk about Maternal Fetal Medicine. What it is, which patients should see an MFM specialist, and more.

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Transcript

Dr. Arnold:
This is Live Well Talk On… Maternal Fetal Medicine. I'm Dr. Dustin Arnold, Chief Medical Officer at Unity Point Health St. Luke's. Maternal Fetal Medicine specialists provide care for women and their unborn babies who have had high risk complications or at risk for them. Here to tell us more about this is Dr. Stephen Pedron, physician at Unity Point Clinic Maternal Fetal Medicine. Thanks so much for stopping by.

Dr. Pedron: 
Good morning Dustin. How are you? 

Dr. Arnold:
I'm well. Let's just start off cause I don't think the common man on the street knows what maternal fetal medicine is. So, just take us through, how does one become that and what are the overall duties of a Maternal Fetal Medicine Specialist?
 
 Dr. Pedron:
All right, good question. Every obstetrician gynecologist is a maternal fetal medicine specialist. They all take care of two patients. They all have a mother and a fetus. So, a maternal fetal medicine specialist has some skills. But really we're obstetrician gynecologists who get some more training. MFMs take care of patients who are referred to us for some other complications. Some problem with the mother or the baby, something that's a little bit more complex or pardon the expression above the pay grade for an obstetrician gynecologist.

Dr. Arnold:
So, if I'm a pregnant woman, which I'm not.

 Dr. Pedron: 
And that's good to know. That'd be a miracle.

Dr. Arnold:
Yes, That would. When should I expect my obstetrician or when should I advocate for myself to say, “Hey, I think I need to go see the maternal fetal medicine specialist.”?
 
 Dr. Pedron:
A good obstetrician gynecologist is going to tee that up before the patient asks for it. They're busy. They're seeing, I don't know, 30, 60, however many patients a day in OBGYN sees in the office and they have great skills for a lot of things, but they'll recognize the high risk criteria that fall out and refer that patient. On the other hand, you may have a patient who's been through something either themselves or with the previous pregnancy and they'll come out of the gate and ask their obstetrician gynecologist for a referral. Some patients pick up the phone and call us. They know they're high risk and they appreciate having the service and they'll try and set up the appointment themselves.

Dr. Arnold:
What are some common high risk conditions or medical conditions that you see in your practice?
 
 Dr. Pedron:
You name it. If it's a medical condition that the patient may have another specialist for. She's on medication, she's had a procedure, she's been hospitalized for something. Hypertension, diabetes, heart disease, cancer, past fetal problems such as demise, early delivery, severe preeclampsia. There's a long list of problems that patients are referred for.

Dr. Arnold:
Cause I'll be with complete transparency as Internal Medicine physician. I think we kind of see pregnancies as black box of once they're pregnant, you know, we're like, okay, we're not, we're out of here. We don't really know what to do. Sometimes I think that fear of caring for the pregnant patient just comes from lack of experience, lack of exposure to two patients at once. So, I know that you do a lot of work with stuff that might be considered bread and butter internal medicine, hypertension and diabetes. Of the two, hypertension or diabetes, which is more challenging to manage?

Dr. Pedron:
Diabetes. In a heartbeat, diabetes. And I think you make a great point. It's the, that black box is what differentiates OBGYN physicians from other physicians. Most non-obstetricians just don't want to touch a pregnant patient because they're afraid of what's happening in there. They can't see it. It has liability associated with it. It's a mystery to them. So, I think that's a big reason why people stay away from our patients. And that's not for nothing, but that's a big reason why it's hard to get other subspecialists to visit with the pregnant patient because they're concerned about just that.

Dr. Arnold:
Yeah. Yeah. It's yeah, you're absolutely, I mean, you completely describe the feeling that the helpless, just because I'm not exposed to it. I don't know. 

Dr. Pedron: 
It's a mystery 

Dr. Arnold:
And you, not that there is a difference, but you just would feel horrible if you made the wrong decision that potentially hurt the mom or the baby, as an internist. You just particularly if it’s something so pedestrian that you shouldn't have missed, you know, if you had just been exposed or trained in that. How does an obstetrician or a family practice doctor that still does obstetrics, how do they get into your clinic? Do they just, they call? Just make a referral? 

Dr. Pedron:
Right. Pick up the phone and call. The best, my favorite referrals are the ones where the provider picks up the phone and calls me and says, “Hey Steve, I've got this problem. What do you think about it?” And we'll either talk that through on the telephone and make some recommendations or ratify what they're doing or they'll get a referral sent over to us.

Dr. Arnold:
So, there's direct communication between you and the obstetrician or the referring physician?
 
 Dr. Pedron:
If I had my druthers, there would always be direct communication. My favorite form of communication is face to face. My second favorite is a telephone call and down it goes to email and text.

Dr. Arnold: 
Yeah. I've always said when they come up with all these elaborate checkouts, and transitions of care policies and procedures these days when I've often said a doctor talking to a doctor, I can tell you more in a prepositional phrase about the patient we're going to care for together than I ever could in some sort of electronic digital format. 

Dr. Pedron: 
You bet. 

Dr. Arnold:
You know? When does someone become referred to? Is it too early? Is it like 10 weeks, 12 weeks, 20 weeks? I mean, is there a certain time that it's too early to see you or they can come at anytime if they have a risk or a condition, that warrants.
 
 Dr. Pedron:
They can then come at any time. It depends. I'll have some patients that are sent very early because they have some problem that needs an intervention in early pregnancy. They need to have Enoxaparin started or they've got type one diabetes and they need their A1C down quickly. Or I'll have patients that are referred in the second trimester because they have an abnormal screening test, genetic test or some other problems cropped up. And I'll have third trimester pregnancies that are developing hypertension. I'll see patients in pre pregnancy consultation who have past history of some problem. They may have a genetic problem in their family or they've got diabetes they'd want to get controlled before they conceive. And one of my favorite consults is actually postpartum and post-mortem consultations for patients who have recent or remote loss. Those patients. It's a little bit of a detective mission to try and tease through what's happened with them and put it together and make some recommendations for how to avoid it in a future pregnancy.

Dr. Arnold:
We talked on a recent podcast, happened to be done yesterday even though that might not be when these are listened to. Where a doctor Abualfoul said that they've recently reduced the reduction of Zika transmission down to two months of abstinence, for the patients, from six. Do you see any Zika concerns, seek infection in your practice?
 
 Dr. Pedron:
No, we don't. It's had a lot of hype. It should have a lot of hype in certain regions. It's a good thing to think of if you see certain fetal problems or you have history of travel to that region. But as many times as I've tested for it, I've never seen a case

Dr. Arnold:
Kind of like, it's like oxygen toxicity on my side of the street. It's like Sasquatch. Everybody talks about it, but nobody has ever really seen it. 

Dr. Pedron: 
Right. 

Dr. Arnold:
So, one last question. How did you get into maternal fetal medicine? Why did you choose that? Now most obstetricians can go into obstetrics and then, or they could go gynecological oncology, in a fellowship or maternal fetal medicine. Why did you choose maternal fetal medicine?
 
 Dr. Pedron:
Wow. Another great question. I chose medicine because I thought it would be a good job. I wanted to make sure that I had a good paycheck and raise my family and I really, in med school I couldn't figure out what I wanted to do. So I chose family medicine and did a couple of years of family medicine and on my family medicine rotation at the rotations at the County hospital in Phoenix, there was a mentor program director, John Kelly, who was just legendary and I fell in love with the guy and fell in love with what he did and just had to have it. Just loved pregnancy, loved what he was doing, loved his manner with patients and switched to OBGYN with the full intention of completing that residency and then doing maternal fetal medicine fellowship.

Dr. Arnold:
I always feel, you know, I know that we have colleagues that are burned out. Some of the studies or the literature is up to 50 or 60% I get up excited every morning to come to work, you know, when I go to bed at night, I can't wait to get up the next day and come back. And I really do feel for our colleagues that don't have that same sort of enthusiasm. And it sounds like you have that too. It's the best feeling in the world. Well, that's really great information today. Thanks so much for taking the time out of your busy schedule. Again, that's Dr. Stephen Pedron physician at Unity Point Clinic Maternal Fetal Medicine. For more information, visit Unitypoint.org. If you have a topic you'd like to suggest for our LiveWell Talk On… podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.