Before the Birth
Advanced Diagnostic and Surgical Techniques Save Lives
Ashley Coleman was referred to the Fetal Care Center of Cincinnati during her pregnancy with Olivia, pictured above, when tests found that a hole in Olivia's diaphragm was allowing organs from her abdomen to grow into her chest cavity. |
| 1981 The first open fetal surgery was performed. |
| 2007 Cincinnati Children's is a world leader in developing fetal surgery techniques to save lives. |
It has been a year of firsts for Mandi Ordonez-Buie – her first child, his first smile, first tooth, first word, first step. She and her husband, Brandon, have experienced the joy of watching Kaidinn grow, each milestone so normal and so miraculous.
Today, Kaidinn is a thriving 1-year-old, but halfway through her pregnancy, Mandi and Brandon faced the possibility of losing him.
At about 19 weeks into her pregnancy, Mandi began swelling ominously. A week later, spot bleeding concerned her enough that she went to the emergency department. There doctors found a tumor – a large mass of abnormal blood vessels on the placenta. The baby's heart was desperately trying to pump blood to his body as well as to the tumor, putting him at risk for heart failure. Working so hard to pump blood, he was urinating a lot and producing excess amniotic fluid that caused Mandi's swelling.
Mureena Turnquest Wells, MD, a maternal-fetal specialist in Mandi's hometown, Evansville, Indiana, referred her to renowned fetal surgeon Timothy Crombleholme, MD, at Cincinnati Children's Hospital Medical Center.
A New Frontier in Medicine
The first open fetal surgery was performed in 1981. Dr. Crombleholme, then a young medical student, read about that operation in the New England Journal of Medicine. It stirred his imagination and shaped his medical career. He was inspired by the prospect of saving a life before a baby is even born.
Today, Dr. Crombleholme directs the Fetal Care Center of Cincinnati, the most comprehensive fetal care program in the country. "I've been fortunate to grow up in this field," he says. "Twentyfive years ago, fetal surgery was far out there – a new frontier. Today, it's an expectation of prenatal care."
Dr. Crombleholme joined Cincinnati Children's in 2004 to build a program that combines a unique interdisciplinary approach with a supportive environment for parents. Today, the Fetal Care Center provides expert maternal care at nearby University and Good Samaritan hospitals, and leading-edge fetal care and fetal surgery at Cincinnati Children's. Families come from across the country for the unprecedented level of care available in Cincinnati.
Dr. Crombleholme offered Mandi a way to save the pregnancy by performing delicate laser surgery to cut off blood supply to the tumor. Following the operation, Mandi spent several days in the Fetal Care Unit at Cincinnati Children's. "My husband had to go back to work. I was in a city where I didn't know anyone, but I felt safe. It was a very comforting environment."
After Mandi went back home, she spent the rest of her pregnancy on bed rest. Kaidinn was delivered by C-section at 39 weeks – a healthy baby, weighing over 8 pounds.
"We are so very blessed for our life we share with Kaidinn," Mandi says. "I'm so thankful the doctors knew what to do for something so rare."
Advances in Fetal Care
Dr. Crombleholme points out that fetal therapies are continually expanding, thanks to strides in diagnostic, medical and surgical techniques.
Ultrasound, initially used to detect a heartbeat, now provides sophisticated, three-dimensional images of organs, muscles and bones of the fetus. In the hands of expert fetal echocardiographers, sound waves now identify heart defects and assess heart function. Ultrafast fetal MRI now obtains detailed images of the brain and other soft tissue in 600 milliseconds – so fast that sedation isn't necessary.
With information from these advanced diagnostic tools, Dr. Crombleholme can offer parents the best options to preserve their baby's life. "As we learn more about fetal abnormalities," he says, "we're continually refining existing techniques and pioneering new approaches."
In a recent week, Dr. Crombleholme performed the first fetoscopic laser surgery to release an amniotic band that was strangling an umbilical cord, open fetal surgery to remove a giant tumor – half the size of the baby – in the chest of a 23-week fetus, and several fetoscopic procedures at 17- to 20-weeks' gestation for twin-twin transfusion syndrome, a condition in which there is unequal blood supply to identical twins.
More achievements are on the horizon. Dr. Crombleholme's research, funded by the National Institutes of Health, is laying the groundwork for new fetal surgery techniques and for fetal gene therapy. He's confident that "five years from now we'll be doing procedures for conditions that currently have no treatment options."
