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Dr. El Kady consults with staff ultrasound techs Rochelle Jacala and Amanda L. Maidhof on a patient's scan. CDEs can reach out to patients on a weekly basis to track blood sugar control and provide advice, saving patients extra travel time and unnecessary appoint- ment s. Thei r ex per tise i n nutr ition a nd exercise ca n a lso help expecta nt mothers prevent gestationa l diabetes from developing. For patients who do not have pre- ex ist i n g d iabet es or a h i g h r isk for developing gestational diabetes, CDEs are also available for general nutritional and exercise advice during pregnancy. "Women who avoid excessive weight ga in during preg na ncy a re a lso less l i kely t o have a Cesa rea n sec t ion ," Dr. Rosner says. SONOGRAPHY SERVICES Though patients' prima r y OB-GY Ns canˆtypically provide basic ultrasounds and other imaging services, the South Na s s a u C ent er for M at er n a l Fet a l Medicine o€ers advanced imaging that ca n determine the presence of intra- uterine growth restriction, hemoly tic d isea se of t he newbor n ( H DN ) a nd other conditions. " For exa mple, placenta previa ca n be diagnosed using a standard vaginal ultrasound," Dr. Rosner says. "However, placenta previa carries a risk of vasa previa, which can only be ruled out using a colored Doppler that not all OB-GYN doctors can provide. We can perform those types of procedures here." Sonography services include both 2-D and 3-D ultrasounds, which can be used to examine fetal well-being, anomalies and growth. Women with low-risk pregnan- cies will usually undergo two or three ultrasounds throughout gestation, while high-risk pregnancies may require more frequent imaging. In most cases, 2-D ultrasounds are enough to monitor fetal progress and check for abnorma lities, but 3-D ultrasounds can be used to better prepare surgeons and parents for condi- tions such as clubfoot or cleft lip. "Of ten, 3-D u ltra sou nds ca n help expectant parents bond with the baby or reassure them if they 're worried," Dr. ElˆKady says. Feta l echocardiography is a type of advanced ultrasound that may be required if physicians suspect the presence of a congenita l heart abnorma lity in the developing baby. Expectant parents with a family history of heart defects or an elevated risk due to medication, obesity, diabetes, or a multiple birth or in vitro pregnancy are prime candidates for fetal echocardiography. In these cases, patients are referred to a pediatric cardiologist outside of the center who can perform the fetal echocardiogram. "We can detect the most common anom- alies here at the center — about 80 percent," Dr. Rosner says. "However, fetal echocar- diography can detect over 90 percent of heart anomalies in cases that require it." Both Drs. Rosner and El Kady examine fetal echocardiogram results and work closely with pediatric cardiologists to determine treatment plans. The South Na s s a u C ent er for M at er n a l Fet a l Medicine plans to add a Mount Sinai tra ined pediatric ca rdiolog ist to its sta€ by summer 2018. In the interim, Ira Parness, MD, Chief of the Division of Pediatric Cardiology at the Icahn School of Medicine and Mount Sinai Hospital will beg in seeing patients to fur ther streamline care and better accommodate 0 8❱❱❱❱❱ C O V E R S T O R Y 0 8