Help for Babies Before They're Born
Advanced fetal diagnosis and treatment for high-risk pregnancies
A decade ago, babies with twin-twin transfusion syndrome (TTTS), a condition in which there is unequal blood supply to identical twins, faced a bleak prognosis.
Now, thanks to advanced diagnostic tools, surgical instruments, anesthetic techniques – and the collaborative efforts of three Cincinnati hospitals – parents whose unborn babies have life-threatening conditions can look forward to a better outcome.
Such success stories illustrate one way Cincinnati Children’s Hosptial Medical Center is improving outcomes for families dealing with high-risk pregnancies, says Kelli Young, RN, MSN, clinical director of the Fetal Care Center of Cincinnati located at Cincinnati Children’s. The only such center in the Midwest, it is a partnership of Cincinnati Children’s, University Hospital and Good Samaritan Hospital.
The center offers evaluation for at-risk mothers, confirmation of the diagnosis of the fetus, nondirective counseling about available options and either treatment or collaboration with the referring physician for postdiagnosis follow-up.
Weighing the Options
Accurate diagnosis of the fetus’ condition depends on ever-improving technology, such as ultrasounds and MRIs. Although over 1,600 women have come to the center since it opened in 2004, only 17 percent of those result in surgical interventions, says Ms. Young.
While TTTS is the most common surgery at the center, surgeons there also have been called on to remove rare tumors occurring on the neck, lungs or lower back; correct invasive hernias; and remove obstructions from the fetus’s upper airway.
“With each referral, a team including a pediatric surgeon and maternal fetal medicine specialist lays out all options, including risks for the fetus and the mother,” she says. “We are honest and direct.”
Careful Preparation
All candidates for surgery undergo physical and psychosocial evaluations before the family and clinical team make a final decision.
Mothers have to be healthy enough to go under anesthesia, and must agree to comply with the challenges of staying pregnant. In some cases, mothers remain on bed rest after the surgery, so they need to have a support system in place that allows that option.
Sparing Healthy Tissue
Most often surgical procedures are performed through very small incisions, using thin probes with tiny cameras and lasers on the end, to enter the uterus.
Less frequent are open surgeries, says Ms. Young – “the last resort, and only if the baby would not survive without the surgery. We have confidence when we offer open surgery, but we don’t go into it lightly.”
Mothers undergoing minimally invasive surgery also benefit from newer medicines that prevent them from going into early labor afterwards.
Changing the Outcome
Whether a family’s consultation at the Fetal Care Center ends in surgery or not, the visit influences their future.
“Even if we don’t intervene, we collaborate with the referring doctor for the rest of the pregnancy, helping families plan where and how they will deliver,” explains Ms. Young.
And the best outcome: “In most cases had we not intervened, the baby would have died,” she says, but instead mothers are able to carry to full term and have no trouble getting pregnant again.
