Ultrasound imaging is a cornerstone of care in high-risk pregnancies, providing essential insights into both maternal and fetal well-being and structural development. But who ensures that these images are not only accurate but also of diagnostic quality, capturing even the smallest details?
A maternal-fetal medicine (MFM) sonographer.
MFM sonographers are the unsung heroes of prenatal imaging, acting as the eyes of Maternal-Fetal Medicine specialists. Imagine being the first to see a tiny heartbeat on the screen of a patient with a history of multiple losses or detecting a complication early enough to save a baby’s life—that’s the kind of impact MFM sonographers have every day. Their expertise goes beyond basic imaging, making their role indispensable in managing high-risk pregnancies.
So, what sets MFM sonographers apart? Their training and skills are specialized and essential to optimizing prenatal care and improving outcomes. Below are some key aspects of their work that demonstrate their unique contributions.
Expertise in Complex Obstetric Cases
MFM sonographers specialize in handling challenging and high-risk pregnancies. These may involve conditions such as congenital anomalies that require detailed anatomical assessment, multiple gestations, where each fetus must be carefully monitored for growth and complications, and maternal health conditions like preeclampsia, diabetes, or autoimmune disorders, which can impact fetal development.
Take, for example, a case where a mother presents for a late anatomy at 32 weeks. The sonographer notices vessels near the lower uterine segment with color Doppler and decides to perform transvaginal imaging to get an optimal view. The transvaginal imaging demonstrates cord vessels crossing the cervix, which is consistent with vasa previa. The sonographer’s detection of vasa previa prompts immediate medical intervention, preventing delivery complications.
With their unique skillset, MFM sonographers can identify and recognize sonographic findings or complications early on. Their ability to provide comprehensive imaging enables Maternal-Fetal Medicine Specialists to make timely, critical decisions affecting both short-term and long-term outcomes for mother and baby.
Specialized Examinations and Advanced Imaging Techniques
In high-risk obstetrics, standard imaging alone may not be sufficient to capture the whole picture. MFM sonographers develop proficiency in various specialized examinations and advanced imaging techniques. Some examples below:
- Doppler studies to evaluate blood flow in key vessels, such as the umbilical artery, middle cerebral artery, ductus venosus, and maternal vessels, too! (Figure 1.)
- Fetal echocardiography to assesses complex cardiac structures and detect congenital heart defects. (Figure 2.)
- Fetal neurosonography focuses on detailed imaging of the fetal brain and central nervous system. (Figure 3.)
- In certain cases, 3D imaging may also be used to aid in diagnoses and management. (Figure 4.)
- Detailed Anatomy (76811) and Detailed First Trimester Ultrasounds (DFTUs). (Figure 5.)
Beyond the Image: Critical Thinking in High-Risk Obstetrics
MFM sonographers must possess strong critical thinking skills to adapt to complex obstetric cases’ dynamic and often unpredictable nature. Each scan involves real-time assessment and decision-making. Sonographers must quickly discern between normal and abnormal findings, usually flagging fetal structural anomalies that may require further imaging or immediate intervention. High-risk pregnancies frequently demand deviations from standard imaging protocols, prompting sonographers to use their judgment to determine which additional views or techniques—such as Doppler studies or 3D imaging—are necessary to obtain a complete and accurate assessment. In urgent situations, such as fetal distress or signs of preterm labor, sonographers must prioritize findings and swiftly communicate critical information to the maternal-fetal medicine specialist to facilitate immediate action. These cognitive skills are essential for delivering comprehensive, high-quality imaging that enables timely and accurate diagnoses, ultimately contributing to improved outcomes for mothers and babies.
Becoming an MFM Sonographer: What You Need to Know
Sonographers typically begin their careers by obtaining Registered Diagnostic Medical Sonographer (RDMS) credentials with a specialty certification in Obstetrics & Gynecology (OB/GYN), followed by clinical experience in obstetric imaging. The more experience you gain in performing obstetric and gynecologic imaging, the better prepared you will be. Those who pursue a career in maternal-fetal medicine (MFM) undergo additional training to develop proficiency in high-risk obstetric imaging. Many also pursue advanced certifications, such as fetal echocardiography, to further validate their skills in this specialized field. The role requires a combination of technical proficiency, critical thinking, adaptability, and a commitment to continuous learning to stay current with advancements in ultrasound technology and best practices.
A career in maternal-fetal medicine (MFM) sonography is both rewarding and impactful, offering opportunities to make a real difference in the lives of mothers and babies. Sonographers play a pivotal role in high-risk pregnancies, often being the first to detect critical conditions that can change the course of care. Beyond the emotional rewards, the field also offers career growth opportunities. With advancements in ultrasound technology and an increasing focus on women’s health, MFM sonographers can pursue advanced roles as educators, advanced practice sonographers, or administrative leaders, allowing them to expand their expertise and advance their careers. For many, the opportunity to combine cutting-edge science with compassionate care makes this profession impactful and fulfilling.
Are you interested in learning more about the role of MFM sonographers or how to become one? Join the AIUM’s interactive community discussion hub, “The Ultrasound Forum: Specialized Skills of Perinatology Sonographers,” on March 19, 2025, at 7 pm EST. Hear firsthand from MFM sonographers, physicians, and other experts in the field. Don’t miss this opportunity to ask questions, gain insights, and connect with professionals shaping the future of maternal-fetal care.
Mishella Perez, BS, RDMS, RDCS, FAIUM, is a Clinical Ultrasound Educator at Scripps Health’s Division of Maternal-Fetal Medicine (MFM) in San Diego. She is also Chair of the American Institute of Ultrasound in Medicine’s (AIUM’s) Obstetric Ultrasound Community and is on the AIUM Board of Governors.
