Taking Care Of Mama And Fetus

By Dr. Keith Ogasawara
Interviewed by Melissa Moniz
Wednesday - March 12, 2008
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Dr. Keith Ogasawara

Dr. Keith Ogasawara
Chief of Obstetrics and Gynecology at Kaiser Permanente Hawaii
Interviewed by Melissa Moniz

How long have you been at Kaiser?

I have been practicing at Kaiser Permanente as full-time staff since 2000, but have been a contractor with them since about 1996.

What’s your area of specialty?

My area of specialty is called maternal-fetal medicine, also known as perinatology. Because there was confusion between perinatology and neonatology, the name of the specialty was changed a few years ago to maternal-fetal medicine. The specialty involves the care of mothers with medical complications during pregnancy, prenatal diagnosis, fetal surgery and fetal therapy. So it’s a sub-specialty of obstetrics, similar to how cardiology is a sub-specialty of internal medicine.


How much of your practice is actually working within maternal-fetal medicine, and how much is general practice?

My practice right now is 100 percent maternal-fetal medicine. A lot of my time is spent doing prenatal diagnosis including obstetrical ultrasounds and things of that nature. It’s primarily a consultative practice. When a general obstetrician/gynecologist has a patient with a problem they refer them to me and I consult and co-manage the patient. If they are seriously ill or have multiple problems, those are the ones I take on as patients.

What are the more common problems you work with?

The most common one is probably premature labor and the medical complications in pregnancy. The most common problems include hypertension, gestational diabetes, diabetes and preeclampsia, which is a high-blood pressure disease in pregnancy.

Dr. Ogasawara performs an ultrasound on patient Ashley Bulosan
Dr. Ogasawara performs an ultrasound on patient Ashley Bulosan

Do the problems generally affect the mother more than the fetus?

It often affects both the mother and her fetus. A lot of the typical medical complications involve the mother, but the mother and baby is really one unit. So there are two patients at risk and it becomes a real balancing act. Sometimes it’s the mother who has the complications, and in other instances it’s the baby who has the complications. Sometimes we have to make concessions concerning the well-being of the mother in an effort to get the baby further along in the pregnancy, increasing the chances for a healthier baby at birth.

Do you run into situations when the mother will go to whatever lengths to save her baby? Does it ever get to a point where it is no longer the parent’s choice?

No, it is always the parents’ choice. But oftentimes, yes, I think you’re right to think that a mother will often sacrifice her well-being for the sake of her baby. I think it’s the maternal instinct, because moms will usually say, “Do whatever it takes for the health of my baby; risk my health for my baby.” It’s very rare for a mother to say, “I’m more important.”

Do you work with problems with pregnancy as far as infertility?

I work with infertility doctors when they have a patient who is interested in infertility treatment but has a medical or genetic condition. In those instances, I evaluate the patient and make recommendations or give the patient information before they get pregnant.

Do you do delivery?

I do a few, but not many. I cover labor and delivery during the day as the back-up physician, so if something happens and the on-call OB/GYN needs someone to fill in, I will. Otherwise, the only scheduled deliveries I do are for patients who have multiple medical complications, or one who has a baby with multiple problems I am caring for.


Is it true that the older you get, the more chance of complications and problems during pregnancy?

It is, in a sense, true. As women delay having kids, they have more problems with infertility. But we also do see complications with pregnancy, like gestational diabetes and hypertension that increase as women get older. There’s also an increased risk for the baby with chromosome birth defects.

What’s the prime baby-making age?

If you look at the complication curve, the prime age for women to have kids is in their 20s. As you get older, it’s a slow progression for more complications. However, there is no sudden rise or absolute age where someone should not have a child.

Does that age only pertain to women, or does the age of men also factor in?

A man’s age isn’t that great of a factor. There is an increased risk of new autosomal dominant mutations in the sperm of older men, but that doesn’t occur until about age 65. The risk never exceeds 1 in 200, so it’s not a significant risk. Men are constantly making new sperm as opposed to women, who are born with a set number of eggs. This is why maternal age has a more significant effect for pregnancy.

What do you think has changed most in the field since you started?

Genetics and technology. The new ultrasound machines have just gotten so much better; the progress we’ve made is just amazing. The genetics field has just exploded with all of the DNA testing we can do now. There have been rapid advances in genetics that have affected our ability to diagnose fetal disorder in pregnancy and screen parents for genetic conditions.

Is if fair to say that you can now detect all birth defects?

There’s a 2-3 percent background rate of birth defects in the general population. This is independent of a mother’s age. Prenatal diagnosis can detect about 50-70 percent of birth defects. One of the difficulties is some birth defects can’t be detected because they don’t express themselves early in the pregnancy. With the invasive testing that is currently available, we can actually detect chromo-some birth defects and quite a few genetic syndromes. The difficulty is knowing what questions to ask the patient during the screening process to help us identify certain risks within a family and offer them various testing, based on what those risks are.

Is the early testing done to offer the parents the option to terminate the pregnancy?

Most parents request prenatal testing to reassure them that their baby is normal. This allows them to “enjoy their pregnancy.” Some parents request prenatal testing even though they would never consider pregnancy termination. If these parents have an abnormal test, the early information allows them the opportunity to prepare themselves to accept a special needs child to their family.

Some people think that pregnancy termination is the only reason to do prenatal testing, but that’s not always the case.

There are, of course, some people who do testing for that purpose, but there are also many others who do the test to reassure themselves.

At Kaiser, one of the major goals of our prenatal diagnosis program is the prenatal detection of congenital heart defects. If we are able to prenatally identify a baby with a congenital heart defect, it can really make a big difference for the health of that baby. For example, if a baby has a specific type of heart defect that requires immediate surgery after birth, we would not want that baby to be delivered in Hawaii. The reason is a neonatal open-heart service doesn’t exist in the state of Hawaii. Our goal is to prenatally identify these babies, counsel the family and make arrangements for these patients to deliver on the Mainland at a pediatric heart center.

 

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