Fetal Care Center of Cincinnati Extends Vital Services to Midwestern Families
For more than 120 years, the medical experts of Cincinnati Children's Hospital Medical Center have specialized in the smallest patients, helping them survive and thrive. Now, with the new Fetal Care Center of Cincinnati, the experts are expanding the help they give to the tiniest patients, the unborn.
The Fetal Care Center and its research component – the Center for Molecular Fetal Therapy – are the product of an innovative collaboration involving:
Before the Fetal Care Center opened in mid-2004, "Parents had to travel to San Francisco or Philadelphia for this depth of prenatal diagnostic or therapeutic help. There was nothing in the Midwest," says Timothy Crombleholme, MD, director of the center.
Fetal Care Center of Cincinnati: A Unique Resource
"It's tremendously important to have the Fetal Care Center here, because it's one of only three centers in the world that offer everything, from diagnosis through fetal intervention. That means everything from placing a shunt, to performing fetoscopic surgery through the mother's abdomen, to open fetal surgery where the uterus is exposed.
"Only our center, plus the University of California San Francisco and Children's Hospital of Philadelphia, can offer that range," says Dr. Crombleholme, the only pediatric and fetal surgeon to have worked at all three institutions.
The new center means that women with high-risk pregnancies can have a full range of tests performed in one day, followed by a meeting with Dr. Crombleholme and a maternal fetal medicine specialist to discuss the test results, options and next steps. Other specialists will join the meeting as needed, such as a:
- Cardiologist or cardiothoracic surgeon
- Neurosurgeon
- Geneticist
- Neonatologist
- Family support services counselors
Ongoing Support
Care is available from the prenatal diagnosis through delivery to postnatal care and long-term follow-up, all offered in an atmosphere of family-focused support. The center provides care in conjunction with a woman's primary obstetrician or maternal-fetal medical specialist, but women without referrals are welcome, too.
Women will be offered non-directive counseling, which provides all the information necessary for personal decision-making. If the woman wishes, she can have the support of a Fetal Care Center Ambassador, a personal guide for her and her family as they go through the evaluation process. Families traveling to the Fetal Care Center of Cincinnati from longer distances are offered help with lodging and transportation issues. Translators are available for non-English speaking patients and families.
Improved Outcomes for Fetal Patients
Advancements in neonatology mean that fewer babies die from complications of prematurity today. The new focus of the Fetal Care Center is structural abnormalities, "the leading cause of death in neonatal nurseries now," says Dr. Crombleholme.
The most common structural problems are diaphragmatic hernia, cystic adenomatoid malformation of the lung (a lung tumor), bladder outlet obstruction, sacrococcygeal teratoma (a tumor on the buttocks), and Twin-Twin Transfusion Syndrome (TTTS) , in which one identical twin has too much amniotic fluid and the other too little. All are potentially life-threatening.
"Only 10 percent of our patients require fetal intervention, but the other 90 percent benefit from comprehensive evaluation, because by making an accurate diagnosis we may be able to intervene to change the outcome," says Dr. Crombleholme.
"We can change where a baby is delivered, and what experts are immediately available. We can change when a baby is delivered, which gives families options about timing and delivery techniques. And we can change how a baby is delivered, as with the ex-utero intrapartum treatment (EXIT)."
Innovation to Save Lives
EXIT allows Dr. Crombleholme vital time during the birthing process to correct an abnormality. To deliver a baby with a large neck mass, for instance, Dr. Crombleholme and his team put the mother under deep general anesthesia, relaxing the uterus so he can work on the baby and secure an airway. "I have up to an hour and a half to do the surgery, all the while the baby is supported by the placenta," he explains.
"There are some cases where the infant might not otherwise have survived. One fetus had severe narrowing of the aortic valve, and with EXIT, we had not only placental support, but also a heart-lung bypass machine to connect to the baby. We stabilized the baby for transport to the cardiac catheterization lab. Under a regular delivery, it's doubtful that the child would have made it from the delivery room to the cath lab," he notes.
Many fetal problems don't require surgery. In cardiac arrhythmia, for example, a mother takes a pill that crosses the placenta to control the baby's heart beat. An in-utero blood transfusion often cures anemia.
Research to Shape Future Care
"The things we're doing today are based on research done 10 years ago," says Dr. Crombleholme. "That's part of our mission at the Center for Molecular Fetal Therapy, to develop gene transfer techniques that will be the next stage of development in fetal therapies.
"One day, we will fulfill the promise of prenatal fetal diagnosis. Right now, in some cases we know a fetus has a condition, but we're not able to treat it. In the future, we will diagnose a fetus with cystic fibrosis, then replace the mutated gene in utero so that the child does not have to suffer from cystic fibrosis. That's the ultimate goal."
