Fetal Medicine specialists who consult with pediatric neonatal experts to develop care plans to optimize a baby’s health outcome. Our nurses have specialized training and experience in high-risk obstetrical care, with expertise and certification in fetal monitoring and resuscitation. Close collaboration among our specialists ensures that both mother and baby have access to any subspecialty and diagnostic or treatment option needed. Each patient’s unique situation is presented to prenatal and pediatric practitioners across all specialties. Results from diagnostic tests, consultations and opinions are shared, providing a systematic, collaborative and consensus approach. The Center for Prenatal Pediatrics Dr. Lynn L. Simpson, Chief of Maternal-Fetal Medicine 7 Prenatal Imaging We offer specialized expertise in fetal MRI, sophisticated 3-D and 4-D ultrasound imaging, and fetal echocardiography. Our sonographers and fetal medicine physicians are experts in evaluating fetal development and identifying structural defects. Early, Accurate Prenatal Diagnosis Outcomes are better when diagnosed and treated early. The Center for Prenatal Pediatrics is at the forefront of early, first trimester screening in pregnancy and advanced prenatal diagnostic testing for fetal chromosome abnormalities and birth defects. Some of the disorders we can diagnose and treat prenatally include: • Cardiac arrhythmias • Major heart conditions (treated immediately after birth) • Twin-Twin Transfusion Syndrome (TTTS) • Fetal anemia • Fetal urinary tract obstructions • Bladder obstruction • Neural tube defect • Inborn errors of metabolism • Rare genetic diseases Chorionic Villus Sampling (CVS) Chorionic villus sampling is a first trimester diagnostic tool used for early prenatal diagnosis. We have performed some 643 CVS procedures, more than any other center in the region. CVS is used to detect genetic disorders such as Tay-Sachs disease, sickle cell anemia, cystic fibrosis, thalassemia and Down syndrome. Percutaneous Umbilical Blood Sampling (PUBS) Fetal blood sampling via PUBS, sometimes called cordocentesis, is a very complex procedure performed by specially trained perinatologists as part of diagnosing, treating, and monitoring fetal problems at various times during pregnancy, when other tests or procedures are not possible or not effective. The Center for Prenatal Pediatrics is at the forefront of early, first trimester screening in pregnancy. Between 1980 and 2009, the number of twin pregnancies in the United States rose by 76 percent. Pregnancies with multiple fetuses require heightened prenatal monitoring and specialized clinical management. Maternal-Fetal Medicine subspecialists have expertise in providing this specialized care, from managing identical twin gestations complicated by malformations, to evaluation and treatment of discordant growth and twin-twin transfusion syndrome. Given the increased risk of congenital anomalies in twin gestations, our Maternal-Fetal Medicine specialists recommend a detailed sonographic survey of fetal anatomy in the early second trimester of twin gestations. In monochorionic twin gestations and dichorionic twin pregnancies conceived using assisted reproductive technologies, our specialists suggest fetal echocardiography because the risk of congenital heart disease is increased in these populations. In Utero Diagnostic Procedures Our Maternal-Fetal Medicine specialists have pioneered in utero fetal procedures to diagnose and treat some of these serious complications using chorionic villus sampling, radiofrequency ablation, fetal blood sampling and transfusion, and drainage and shunt procedures. Non-Selective Reduction & Selective Termination To improve pregnancy outcome, we offer non-selective multifetal reduction when assisted reproduction techniques result in multifetal pregnancy, and selective termination when the well-being of a healthy fetus is threatened by an anomalous fetus. 8 Multiple Gestation Monitoring & Specialized Care Women carrying multiples are at significantly increased risk for preterm labor and delivery. Abnormalities We Can Diagnose & Treat We have particular expertise in diagnosing and treating a range of problems affecting pregnancies with multiples including: • Preterm labor • Intrauterine growth restriction • Birth defects and genetic syndromes • Monoamniotic twins • Twin-Twin Transfusion Syndrome (TTTS) • High-order multiples • Twin Reversed Arterial Perfusion (TRAP) – also known as acardiac twin Twin-Twin Transfusion Syndrome/Laser Photocoagulation As the number of women having twins has increased, so have the chances of developing a serious pregnancy complication called Twin-Twin Transfusion Syndrome (TTTS). This disorder affects as many as 15 percent of identical twin pregnancies and results from uneven blood flow between the fetuses. Successful treatment of this complex condition requires advanced training and experience available at only a few specialized perinatal centers in the United States. In more than 70 percent of cases, both twins will die if this syndrome is not treated early in pregnancy. Over last three years, our Maternal-Fetal Medicine specialists performed more than 76 laser photocoagulation procedures, a minimally invasive laser treatment which involves coagulating unnecessary and harmful