Connexions Spring 2020

from diagnosis to delivery: early prenatal intervention improves outcomes

At the Cincinnati Fetal Center, our innovative treatment options bring real hope to families. Led by physicians from Cincinnati Children’s, TriHealth and University of Cincinnati Medical Center; we are dedicated to exploring the unique challenges that face each patient and unborn baby from diagnosis to delivery.

One of a few comprehensive fetal care centers in the world, we are specially equipped to care for fetal abnormalities like spina bifida, a birth defect that occurs when the bones in a baby’s spine do not fully form during early pregnancy.

Spina bifida can range from mild to severe. A child born with the most severe form of spina bifida, myelomeningocele (MMC), can experience serious health problems, such as hydrocephalus (an excessive accumulation of fluid in the

brain) and paralysis. The severity of paralysis depends on where the opening occurs in the spine. At the Cincinnati Fetal Center, we offer options for early in-utero intervention that may improve the overall outcome.

The Right Decision for Your Situation When a family comes to us, they can meet with a full range of multidisciplinary specialists within a few days of their initial call to the center. Our team includes maternal-fetal medicine specialists, fetal surgeons, pediatric neurosurgeons, neonatologists, genetic counselors, developmental pediatricians and social workers. Your referring obstetrician and/or maternal-fetal medicine specialist are welcome to participate in team meetings via video teleconferencing.

“When families talk to a full range of specialists, they can make the most informed decision about the right procedure for the optimal outcome in their specific situation,” says Dr. Jose Peiro, Endoscopic Fetal Surgery Director.

Our team works with each family to determine if fetal surgery is a possible solution. Fetal surgery for MMC can offer significant benefits to the baby, but it also carries serious risks and potential complications. Our team provides extensive testing and counseling to ensure that patients meet the criteria and have all the information they need to make an informed decision about whether to undergo the procedure.

Early Interventions, Optimal Outcomes At the Cincinnati Fetal Center, we can do prenatal repairs for MMC while the baby is in utero. Our surgeons have considerable

experience performing open and fetoscopic operations.

Prenatal surgery for MMC takes place between the 19th and 25th weeks of pregnancy. Unlike in the open surgery where the doctor makes an incision across the mother’s abdomen and opens the uterus, the fetoscopic procedure is much less invasive. The neurosurgeon removes the myelomeningocele sac and releases the spinal cord, and the fetal surgical team repairs the spinal defect in layers before closing the skin to protect the spinal cord from exposure to amniotic fluid.

“With the fetoscopic procedure, we’re able to achieve the same positive neonatal outcomes as with open surgery. The baby

does better postnatally if we avoid prematurity and it’s much less risk with fewer complications for mom,” says Dr. Jose Peiro.

Women who undergo the fetoscopic procedure have the option to deliver current and future pregnancies vaginally, whereas women who have the open fetal surgery must undergo a Cesarean section to prevent any stretching or tearing of the scar that was left on the uterus. When patients do not undergo prenatal surgery, surgical repair takes place after the baby is born. In this situation, we operate on the baby a few days after birth to close the opening in the spine to prevent infection and prevent further injury to the spinal cord and nerves.

However, it cannot correct the established damage in the spinal cord and nerves. Babies who are born with hydrocephalus may need a shunt to help drain the excess fluid from the brain. Shunt placement surgery may take place within the first few weeks after the baby’s birth.

Care Continues After the prenatal procedure, mothers have the option to deliver at Cincinnati Children’s. Our Special Delivery Unit is located inside one of the best pediatric hospitals in the world on the same floor as our topranked NICU.

“When babies are delivered at Cincinnati Fetal Center, they can avoid transportation of the baby after delivery,” says Dr. Peiro.

With newly expanded 24/7 triage for all delivery types, the Special Delivery Unit allows healthy moms whose babies face complex conditions like spina bifida to recover right down the hall from their baby. This offers peace of mind that they need during this time. 38 connexions

Looking Forward The Cincinnati Fetal Center has more than 40 years of experience with spina bifida and have been performing prenatal surgery for nearly a decade. All that experience means they can focus on finding novel therapies to enhance surgical outcomes and enhance quality of life for patients.

“We’re pioneers of this approach --- and one of a few in the world that can do it,” says Dr. Peiro.

Innovation is a hallmark of the fetal center's approach to care. The center is one of only a few in the United States to offer the unique combination of groundbreaking research and best-in-the-world clinical work for patient families.

“I have a lab here where the main focus is spina bifida. I’m always working to improve techniques and work with others to lead innovations in spina bifida,” says Dr. Peiro. “Looking ahead, I’d like to intervene even earlier in gestation, to improve the materials we use, and to work with regenerative stem cell therapy and more pharmaceutical treatments.”

Not all fetal conditions require delivery in a Special Delivery Unit. Your medical team at the Cincinnati Fetal Center will work with you to create the best birth plan and delivery location for both you and your baby.

cincinnati fetal center

When you need advanced care for your baby, we’re here for you.

Before, during, and after delivery.

The Special Delivery Unit at the Cincinnati Fetal Center provides one of the world’s only birthing units located inside a pediatric hospital—so you can recover down the hall from your baby. From the moment your baby is born, they are surrounded by the expertise, excellence, and exceptional care that only Cincinnati Children’s NICU and CICU can offer. With newly expanded 24/7 triage for all delivery types, the Special Delivery Unit at Cincinnati Children’s is for healthy expecting moms whose babies face complex conditions such as:

*Congenital diaphragmatic hernia (CDH)

*Fetal heart conditions

*Spina bifida (myelomeningocele or MMC)

Regardless of condition, the medical team at the Cincinnati Fetal Center works with each patient family to ensure the best plan and delivery location for both mom and baby.

1.888.FETAL59 info@fetalcarecenter.org www.fetalcarecenter.org