Specialty Obstetrics of San Diego

Welcome to Specialty Obstetrics of San Diego, a practice that is dedicated to compassionate and personalized care of pregnant women. Our physicians are board certified obstetricians and have received additional high risk training and certification in Maternal-Fetal Medicine. Their expertise is complemented by a highly qualified team of sonographers, genetic counselors and a labor delivery nurse practitioner. We take pride in being a state-of-the-art facility that uses a paperless electronic medical record. Specialty Obstetrics of San Diego strives to make your pregnancy a memorable experience while achieving the best outcome for you and your baby.

Services

High Risk Pregnancy Consults

High Resolution Ultrasounds

Genetic Counseling

Chorionic Villus Sampling (CVS)

Fetal Transfusion

Amniocentesis

Complete Prenatal Care

CA State Approved Prenatal Diagnosis Center

Specialty Obstetrics of San Diego offers consultative services to assist OB-GYNs in the management of high risk pregnancy. Outpatient consultations are performed at our Carmel Valley office. Our physicians are also available for inpatient consultations at Sharp Mary Birch Hospital for Women and Newborns. Our physicians are uniquely qualified to care for your high risk pregnancy since they have gone on to pursue additional training and board certification in the field of Maternal-Fetal Medicine.

Many patients are referred by their primary obstetricians for consultation when risk factors are identified during their pregnancies. In these cases, our physicians will co-manage the pregnancy with the referring obstetrician to provide the most effective, comprehensive care to patients. Other patients that have had prior pregnancy complications or that have serious medical problems often schedule a consultation visit on their own to discuss the possible implications for future pregnancies.

Specialty Obstetrics of San Diego uses the latest in ultrasound technology to provide patients with the full spectrum of ultrasound services performed in pregnancy.

Our physicians have been specially trained in ultrasound and the diagnosis and managements of problems should they arise. Studies have shown that ultrasounds performed in specialized centers such as ours with Maternal-Fetal Medicine specialists, have a higher detection rate for abnormalities in with the baby, placenta, or cervix.

How is an ultrasound performed?

Transabdominal ultrasound

This is the standard type of ultrasound; the patient lies on her back and ultrasound gel is placed on her abdomen over the uterus. A probe is then placed on this area and an ultrasound image of the baby is displayed on the screen. The sonographer (specially trained technician) then obtains the standard views of the uterus, ovaries, placenta, and baby. This includes measurements of the baby which can help to tell us about the baby’s growth and the due date.

Transvaginal ultrasound

In this type of ultrasound, the patient is repositioned into a standard pelvic exam position and a narrow probe is covered and inserted into the vagina. The transvaginal ultrasound is usually only performed if the transabdominal images are not adequate. It is performed most often to evaluate the following:

1. Cervix – length and dilation
2. Placenta – especially if it looks abnormally low on the transabdominal scan
3. Uterus and ovaries – especially in the first trimester
4. The baby – early in pregnancy when the uterus is small or later in pregnancy when the baby is low in the pelvis

First Trimester

A first trimester ultrasound is usually performed at the first OB visit to check for a fetal heart beat, measure the baby to determine the best due date, determine if there the number of fetuses, and to look at overall appearance of the pregnancy, uterus and ovaries. This most often is performed by the patient’s primary obstetrician.

Patients are usually referred to our office in the later part of the first trimester between 11 and 14 weeks gestation. At this time, we perform a detailed exam of the baby’s anatomy. Our program is on the cutting edge of detecting abnormalities at this early stage. Many severe birth defects can be detected at this point and so a normal scan is very reassuring. Additionally, it is the period during which the nuchal translucency can be measured. The nuchal translucency is a fluid filled layer present on the back of every baby’s neck. The measurement of this layer has been shown to be useful in the prediction of birth defects. A baby with a large nuchal translucency measurement is at increased risk for genetic and other birth defects.

The nuchal translucency measurement is also a component of the California Prenatal Screening program and is combined with routine blood tests to determine the risk for Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18). Approximately 85% of babies affected by trisomy 21 and 95% of baby with trisomy 18 can be identified by this screening. About 5% of normal babies will have a false positive test. A positive test does not mean your baby has trisomy 21 or trisomy 18, but rather that you are a candidate for further testing. Specialty Obstetrics of San Diego providers are certified by the State to perform first trimester screening.

Anatomic Survey

An anatomic survey is usually performed at between 18 and 20 weeks. It is the best time to evaluate your baby’s anatomy. Our physicians, as specialists in Maternal-Fetal Medicine, are uniquely trained to perform detailed ultrasound examinations of your baby. We perform high resolution second trimester ultrasounds to detect fetal anomalies. We also are experts in the use of ultrasound to detect fetal “soft markers” which may be seen in some fetuses with genetic abnormalities. Thankfully, most ultrasound examinations are normal, reassuring, and a joyful experience for the patient. We provide patients with pictures of their baby to remember the experience.

Fetal Echocardiogram

A fetal echocardiography is typically performed between 22-24 weeks gestation. Heart defects affect 1/100 to 1/200 babies and the defects can range from mild to life threatening. Fetal echocardiography can detect 70-80% of the major heart anomalies. Our prenatal diagnostic program has obtained special certification from the American Institute of Ultrasound in Medicine (AIUM) to perform this very specialized exam.

Fetal echocardiography is performed on all pregnant women whose babies are at increased risk for cardiac defects. Factors that increase risk include:

– Mothers with diabetes existing before pregnancy or diagnosed in the first trimester
– First trimester exposure to medications or agents known to cause birth defects
– Patients with seizure disorder, even if not on medication
– Patients with a prior child born with heart defects
– Patient or husband born with heart defect
– Patients whose babies are at risk for genetic problems such as genetic syndromes
– Suspected fetal arrhythmia or heart defect on previous ultrasound
– Fetuses with other anomalies detected on previous ultrasound
– Single umbilical artery
– Fetuses with thickened nuchal fold
– Fetuses with chromosomal abnormalities
– IVF pregnancies
– Twin pregnancies where the twins are sharing a placenta

Cervical Length

The length of the cervix tends to shorten during pregnancy. Sometimes it shortens too soon increasing the risk of preterm labor and premature birth. In patients with a history of premature birth, the cervical length is an important part of second trimester follow up exams, most often performed transvaginally every 2 weeks.

Fetal Doppler

Fetal Doppler ultrasound is a technique used in high risk pregnancies to assess the blood flow through the placenta and fetal brain. These exams are especially useful in cases of suspected growth restriction. In addition, in mothers with isoimmunization who have antibodies against their fetus’ red blood cells, it can be used to detect anemia.

Genetic counseling is a very important service for pregnant women for a variety of reasons. As a women ages, her risk for chromosomal abnormalities such as Down’s syndrome increases. The genetic counselor can review your various risk factors, family history and the results of your combined first and second trimester screening to determine if you are a candidate for further genetic testing such as amniocentesis. The genetic counselor can also review more precisely what an abnormal test means, for you individually as well as the options that are available.

*Please call us for inquiries and appointments (858) 794-7700

Chorionic villus sampling (CVS) is a procedure that can be performed between the 10th and 12th week of pregnancy to test for chromosomal abnormalities and some inherited genetic diseases. Deciding whether or not to have CVS usually depends upon your particular risk factors and your concerns, but the decision regarding genetic testing is entirely up to you. CVS may not be able to be performed if you have an unusually shaped uterus, unusual fetal or placenta position or infection. If CVS is not performed, another diagnostic procedure called amniocentesis, may be done about 4-6 weeks later.

Many tests can be done on a chorionic villus sample. Most patients have the test to make sure that the baby does not have a chromosome abnormality. The most common chromosome abnormalities (Down syndrome and trisomy 18) account for about two-thirds of all the chromosome abnormalities that can be detected by CVS. The standard laboratory testing detects over 99% of common chromosome abnormalities. Most chromosome results are available within 7-10 days.

In some patients who are carriers for genetic diseases, CVS can also be used to test them. Examples include Tay Sachs disease, sickle cell disease and cystic fibrosis. Tests for rare genetic diseases may take up to 5 weeks. Unlike amniocentesis, CVS cannot be used to test for open neural tube defects, such as spina bifida and anencephaly. Since the CVS procedure is done relatively early in the pregnancy, ultrasound evaluation of the fetal anatomy is limited. It is recommended that the patient return in 4-6 weeks for a detailed anatomical ultrasound survey.

Although CVS is a routine procedure, it does have some risks including less than a 1/100 risk of miscarriage, infection, harm to the fetus (<1/3,000) or need to repeat the procedure due to inadequate specimen. These risks are related to practitioner experience.

*Please call us for inquiries and appointments (858) 794-7700

Our practice has the experience and expertise to perform this highly technical procedure orchestrated through the skilled staff at SHARP Mary Birch Hospital.

The fetus is initially evaluated with Doppler and real-time ultrasound for anemia. Transfusion is initiated when these parameters indicate a concern for a low blood count. Indications for transfusion can include red blood cell isoimmunization, parvovirus, and homozygous thalassemia.

An amniocentesis is a procedure used to obtain a sample of the amniotic fluid from around the baby. The amniotic fluid can provide useful information about the health of the fetus. Some of the tests that can be performed on amniotic fluid include:

– Testing for fetal chromosome abnormalities like Down syndrome
– Testing for genetic disorders such as cystic fibrosis
– Testing for fetal infection
– Testing for fetal metabolic problems
– Confirm the results of Non Invasive prenatal testing because of its high false positive rate

The most common reason that patients choose to have an amniocentesis is to make sure that the baby does not have Down syndrome or a similar type of chromosomal abnormality. This is most often a concern when a patient is over the age of 35 (the risk increases with age) or when their California Prenatal Screening test is positive. However, any patient can have an amniocentesis.

An amniocentesis is usually performed at between 15 and 22 weeks gestation. Since chromosome testing results may take up to 2 weeks and results for more specialized testing can take even longer, most patients choose to have their amniocentesis earlier in this window.

There is a risk of miscarriage associated with amniocentesis but it is small. The risk of pregnancy loss in studies of amniocentesis ranges from 1:300 to 1:1600. Our practitioners are experienced experts who have been doing the procedure for many years. Studies have shown that loss rates are related to the provider’s experience.

*Please call us for inquiries and appointments (858) 794-7700

Our practice accepts new patients to be seen as our total care patients.

Our Maternal-Fetal Medicine Specialist, take care of your entire pregnancy complemented by a highly qualified team of sonographers, genetic counselors and nurse practitioner to ensure you have the best outcome and the most enjoyable experience during you pregnancy.

Specialty Obstetrics of San Diego is a State Approved Prenatal Diagnosis Center. Patients with screen positive results through the program can be referred to our practice for genetic counseling, ultrasound and diagnostic services.

A woman with a Screen Positive result will be called by her doctor or clinic. She will be offered follow up services at State Approved Diagnosis Center. Those services are: Genetic Counseling and a Diagnostic Ultrasound. The counselor explains the test results and also possible follow up test like: Prenatal cell free DNA, CVS, Amniocentesis. All of these can be done at Specialty Obstetrics of San Diego.

For information about California Prenatal Screen Program visit California Department of Public Health.

Special Monitoring Programs

Twins, Triplets…

Preterm Birth Prevention

Fetal Growth

The Maternal-Fetal Medicine specialists at Specialty Obstetrics of San Diego have used the latest available published studies to design a program specifically tailored to the care of patients with multiple gestations. The program includes specialized dietary counseling, education, ultrasound assessments and customized appointment scheduling to meet the unique needs of twin and triplet gestations. Our doctors are specially trained to recognize and treat the complications that can arise with patients and their babies.

*Please call us for inquiries and appointments (858) 794-7700

The Maternal-Fetal Medicine specialists at Specialty Obstetrics of San Diego have used the latest available published studies to design a preterm birth prevention program for patients at increased risk for preterm delivery. These patients include patients with a history of preterm birth or with a condition that increases the risk such as incompetent cervix, multiple gestation or uterine abnormality. Patients receive special education, more frequent ultrasound assessments of the cervix, and treatments designed to reduce the risk of preterm birth.

*Please call us for inquiries and appointments (858) 794-7700

Twin-Twin Transfusion Syndrome

Twin-twin transfusion syndrome (TTTS) is a serious condition that can occur in pregnancies when identical twins share a placental circulation. While in most cases of identical twins, blood is shared equally, in some cases, there is an unequal sharing resulting in twin-twin transfusion syndrome. In this situation, the donor twin sends more of the blood to the other twin resulting in a small fetus with anemia and low amniotic fluid in that sac. On the other hand, the recipient twin receives an excessive share of blood supply resulting in a high blood count, excessive amniotic fluid, and large size. These types of twins are at increased risk for pregnancy loss, preterm birth, stillbirth, and long term complications including neurologic problems. Our physicians are specially trained in the management of high risk twin pregnancies.

TAPS

Twin anemia polycythemia sequence (TAPS) is a form of twin-to-twin transfusion syndrome (TTTS) that can complicate monochorionic twin pregnancies. In a monochorionic pregnancy, identical twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are susceptible to complications like TTTS and twin anemia polycythemia sequence (TAPS) which generally is a result of unequal sharing of placental circulation.

Selective Growth Restriction

Twins pregnancies are at risk for intrauterine growth restriction and identical twins are at risk for selective growth restriction in which one of the twins is small (less than the 10%) and the other is of normal size. This is thought to be caused by unequal sharing of the placenta and requires special ultrasound (Doppler) for proper surveillance of fetal well being.

Progesterone

Treatment with progesterone during pregnancy may help some women reduce their risk for premature birth. If you have a short cervix during you pregnancy or had a previous spontaneous premature birth, you may benefit from this treatment.

Cervical Length

The length of the cervix tends to shorten during pregnancy. Sometimes it shortens too soon increasing the risk of preterm labor and premature birth. The earlier premature birth happens the higher the risks. Monitoring the measurement of your cervical length is very important during your pregnancy.

Cerclage

In order to prevent premature labor our providers might recommend a cervical cerclage, which is surgical procedure where the cervix is stitched, closed with sutures. A Cerclage is not used in every pregnancy with an incompetent cervix; the probabilities are higher if a woman’s cervix is at risk of opening under the pressure of the growing pregnancy.

The Small, Normal Fetus

Many patients are referred to our practice for suspicion of a growth restricted or small baby. This can be either from fundal height measurements or an ultrasound performed through your doctor’s office. Many babies are “normally” small. These babies are actually normally grown for their genetic potential. We perform detailed ultrasounds and Doppler measurements to differentiate the normally small fetus from a growth restricted fetus. Many times, this requires several ultrasounds to assess growth.

The Growth Restricted Fetus

Some babies are small due to impaired growth. Impaired growth can be due to fetal abnormalities (including genetic disorders), maternal factors such as hypertension, and problems with the placenta. Our physicians perform detailed ultrasounds in an attempt to identify the problem and recommend appropriate management. Studies can include several ultrasound to judge interval growth, Doppler studies of the fetus and umbilical cord to evaluate circulation, and, in rare circumstances, amniocentesis to test for genetic disorders.

Our Doctors

Jennifer Ahn, MD

Maternal-Fetal Medicine

David Dowling, MD MBA

Maternal-Fetal Medicine

Yvonne Gollin, MD

Maternal-Fetal Medicine

Our Sonographers

Becca Flick, BS, RDMS

Perinatal Sonographer

Lyna Ha, RDMS, RDCS

Perinatal Sonographer

Linda Le, BS, RDMS

Perinatal Sonographer

Linh Vo, RDMS

Perinatal Sonographer

Sue Wolfe, RDMS

Perinatal Sonographer

Hospital Affiliations

Sharp Mary Birch Hospital for Women & Newborns

Our hospital activities are concentrated at Sharp Mary Birch Hospital for Women and Infants. Mary Birch is the only hospital in San Diego that cares only for women. Over 9000 babies are delivered at the facility each year. The hospital also has an 84 bed newborn intensive care unit with 24/7 neonatology coverage. Rady Children’s Hospital is connected by a tunnel to allow easy transfer of babies that require surgery such as babies with heart defects.

Our activities at the hospital including providing consultation services for patients with high risk pregnancies. We are also available to help obstetricians manage the occasional patient with unexpected complications. We deliver our own high risk pregnancy patients at this hospital. We also our contracted by the hospital to receive maternal transports from other San Diego hospitals as well as hospitals as far away as Riverside and Imperial counties.

High-Risk Pregnancy Care at Sharp Mary Birch

Sharp Mary Birch Hospital for Women & Newborns offers care you can count on. Specialty Obstetrics of San Diego physicians are contracted by the hospital to provide 24/7 coverage for any high risk pregnancy needs. Sharp Mary Birch has the largest Perinatal Special Care Unit in San Diego County and more high-risk pregnancies are referred to here than anywhere else. In the Antenatal Diagnostic Center, monitoring such as non-stress tests and ultrasounds can be used to check for a healthy heartbeat and measure the amount of amniotic fluid around your baby if this testing is indicated. SMBH also provide a range of special services to mothers. For more information visit the SMBH website.

Other Area Hospitals

We work closely with obstetricians affiliated with other area hospital systems including Scripps and Palomar Medical Centers. We provide telephone and outpatient consultations for high risk patients. We also accept transports of patients requiring delivery at Sharp Mary Birch Hospital either due to the need for Level 3 NICU or delivery close to Rady Children’s Hospital.

Accepted Insurance

This may not be a comprehensive list. Please call us today to see if we accept your insurance at (858) 794-7700.

• Aetna PPO
• Anthem Blue Cross PPO
• ARCH
• Blueshield of California
• Champ VA
• CIGNA PPO
• GEHA
• Health Net PPO
• Medi-Cal

• Sharp Community Medical Group
• Sharp Direct
• Sharp Health Plan
• Sharp Rees Stealy
• United Health Care PPO
• Tribal PPO
• Tricare Prime
• Tricare Reserve
• Tricare Standard
• Triwest – Department of VA

Cash Pay Packages

If your insurance is not accepted by our practice, or if you do not have insurance, we offer discounted cash pay rates for any service that we offer.

In addition, some patients seeking specialty prenatal care ask for our total pregnancy care Cash Pay Package. The charge depends on the patient’s pregnancy risk factors (for instance, patients with twins are charged more than those with one baby). The quoted package will include all of our professional services: office prenatal visits, ultrasounds, and delivery. The package does not include lab fees, hospital charges, and anesthesia charges. Please contact our office for more information.

Patient Testimonials

I was referred to this practice after being diagnosed with a high risk baby. This was my second pregnancy, the first I was not with this practice. The difference in care was night and day, all my appointments leading up the birth and the birth itself were 5 star. The ultrasound technicians really know their stuff too. They were never more than 10 minutes late for my visits and the office never felt too full with patients. Thank you for everything!!!

I had a great experience here! I've been twice as a referral from my OBGYN for the 12-week and anatomy scans. Both ultrasound nurses were very kind and professional, especially the one I saw today for the 18-week anatomy scan. The two doctors who came in after to explain the results were also very thorough and gave me time to ask questions. The office staff is very professional and both appointments were right on time. I would highly recommend coming here and I'm glad my doctor recommended it. Also the office has lots of parking and a nice, roomy waiting room with lots of space for social distancing.

Have nothing but INCREDIBLE things to say about this place and my experience! They saw me on-time. The waiting room was clean and empty. My technician was sooooo amazing/friendly/personable. Her name was Linda 🙂 She made me comfortable and talked me through my appointment and was patient. Than the doctor came in for an overview and was very nice too! Would literally give this place 10 stars!!

1 million stars for this facility and for the lovely Becca. From day one she's been nothing but of course professional but it's more than that she is genuine and sweet great at her job makes you feel extremely comfortable and just very pleasant to have along the special journey. It's my first baby but I have to just say that this place is very welcoming clean nice looking which is always great the staff is very friendly professional and great and Becca is just beyond. Something very special about her!!! Xx

Specialty Obstetrics provided our family with phenomenal medical care through the birth of our 4 children over the past 5 years. This is a practice of highly skilled and competent physicians and providers. I've been seen by almost everyone who has worked at the practice during the past 5 years, and my experience with all of them is that they deliver great care with excellent bedside manner. Throughout my 4 pregnancies I always felt that my care options and medical condition of both me and baby were explained thoroughly, I was enabled to make well informed decisions, and that I was supported by the physicians in those decisions.

Since having received care at this facility for 2 previous pregnancies, and now a third, I can tell you I have been very impressed. All the nurses, technicians, and doctors are very pleasant, caring, and personable, especially Sue and Linda. They have pleasant dispositions and can give you a good laugh. All good things when having babies late in life when things are a bit risky and scary.

Contact Special Obstetrics Of San Diego

12264 El Camino Real, Suite 204, San Diego CA 92130

12264 El Camino Real, Suite 204 San Diego CA 92130

Phone: (858) 794-7700 Fax: (858) 794-7744

Phone: (858) 794-7700

Fax: (858) 794-7744

info@specialtyobstetrics.com