Re-evaluating the role of the MFM specialist: Lead, follow, or get out of the way

Robert D. Eden, Ann Penka, David W. Britt, Ellen J. Landsberger, Mark I. Evans

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective. To assess the effect of sub-specialty prenatal care provided to high-risk obstetrical patients in a community perinatal center as a function of whether consultation and referral to a Maternal-Fetal Medicine (MFM) sub-specialist was at the discretion of the generalist, required by the insurance carrier, or by patient choice. Methods. Demographics, management, and perinatal outcomes for high-risk patients managed exclusively by MFM were compared with those managed by generalists who were later referred to MFM after problems arose. Results. Despite similar demographics, high-risk patients managed exclusively by a single MFM had less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores (1.3% vs. 5.5%, p < 0.001), and lower perinatal mortality rates (8.0/ 1000 vs. 47.6/1000, p < 0.001) than those referred at a later date. Conclusions. In this setting, earlier MFM care resulted in better outcomes. These data suggest that the 'gatekeeper' model of generalist to MFM might be better the other way around.

Original languageEnglish (US)
Pages (from-to)253-258
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number4
StatePublished - Oct 2005


  • Gatekeeper
  • Managed care
  • Maternal - fetal medicine
  • Perinatal mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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