HCA Midwest Health - December 27, 2017

What is a Perinatologist or Maternal Fetal Medicine Specialist?

Perinatologists are physicians experienced in a wide range of multifaceted maternal-fetal conditions. They monitor the health of both mother and unborn baby throughout the pregnancy. A perinatologist specializes in dealing with high-risk pregnancies. These doctors are trained in both obstetrics and gynecology, and they can help expecting mothers deal with complications in their pregnancies. Perinatologists can treat conditions involving the fetus, including arrhythmia, with fetal intervention or surgery. In women with pre-existing medical conditions such as diabetes or lupus, the conditions may worsen and threaten the mother and baby. Perinatologists use special tests and treatments to ensure that both mother and child are healthy. Doctors also deal with complications like preeclampsia that are unique to pregnancy.

What is a Neonatologist?

Neonatologists are doctors who are specially trained to care for newborns, especially infants with health problems that are serious or hard to diagnose or treat. This includes premature infants, and those with serious diseases, injuries and birth defects. If the problem is known before birth, a neonatologist may be needed before or during the baby's delivery, as well as after the child is born. Neonatologists are specialists in conditions that affect newborns, as well as the best ways to diagnose and treat newborns. Their training includes pediatrics and newborn intensive care. They are certified by the American Board of Pediatrics and the Sub-Board of Neonatal-Perinatal Medicine.

What is a high-risk pregnancy?

A pregnancy is considered high risk when the life or health of the mother or fetus is threatened because of a situational circumstance, pre-gestational condition or conditions that occur because of the pregnancy. Some pregnancies are classified as high-risk from the beginning, whereas in other pregnancies a condition develops during the gestational period that makes the pregnancy high-risk.

What conditions can be treated with fetal surgery?

Fetal surgery covers a wide range of interventions aimed at treating a problem the unborn child may have or a complication arising in the pregnancy such as twin-to-twin transfusion syndrome. These procedures can be minimally invasive using needles or a special scope or they can be highly invasive with a large surgery for both mom and the baby. Currently, complications of twin pregnancies where the twins share a single placenta are the most commonly treated disorders. However, other conditions such as spina bifida, bladder obstruction, fluid on the lung, and tumors causing heart failure for the baby can be considered for fetal surgery. Regardless of the condition, it can oftentimes be helpful for families to meet with a fetal surgery team and learn more about a specific condition. At HCA Midwest Health we offer a multi-disciplinary team of Maternal-Fetal Medicine, Pediatric Surgery, Neonatology, Pediatric Cardiology, Social Work, and an array of Pediatric Specialists all dedicated to counseling you through a difficult time and caring for your child through the remainder of the pregnancy and onward.

How safe is fetal surgery?

All surgical procedures are associated with risk. That risk is oftentimes determined by the invasiveness of the surgical procedure and the severity of the condition that is being treated. Unlike any other surgical procedure, in fetal surgery, TWO people are placed at risk: the mom and the baby. Therefore, it is critical that your team is capable of caring for both. At HCA Midwest Health our obstetric team delivers exceptional care for high-risk moms throughout pregnancy and afterwards. Our level III NICU is fully staffed with Pediatric Specialists to care for your baby underneath the same roof.

What follow up care is needed after fetal surgery to ensure a good outcome?

After most fetal surgical procedures, you can resume care with your primary OB, with less frequent visits to the Fetal Surgery Team. In some instances, it is important to have the Fetal Surgery Team guide the delivery plan and this can require more frequent follow-up. At HCA Midwest Health, we maintain a collaborative relationship with the OBs in our region. Consequently, we work closely with them in trying to fulfill your ideal delivery plan as much as possible.

What is twin-to-twin transfusion?

Twin pregnancies where the twins share a single placenta (monochorionic) are prone to complications related to how well the twins are sharing the placenta. Twin-to-twin transfusion syndrome (or TTTS) is a condition that arises in 10% of monochorionic twin pregnancies and occurs when the twins are transfusing their blood from one twin (donor) to the other (recipient). As a result one twin very little to no fluid around it (oligohydramnios) and the other twin has too much fluid (polyhydramnios). In some cases, TTTS can be observed with frequent checks. However, when it progresses to more advanced stages and either of the twins is showing signs of heart failure, TTTS can be fatal for both twins in more than 90% of cases. There are minimally invasive procedures that can be performed with little risk to the mom and markedly improved survival for the twins. At HCA Midwest Health we have a highly skilled team inclusive of Maternal-Fetal Medicine, Fetal Surgery, Neonatology, and Pediatric Cardiology to help monitor your twin pregnancy and, if needed, intervene.

What is a congenital diaphragmatic hernia (CDH)?

The diaphragm is a muscle that helps us breathe. It also separates the chest cavity from the abdominal cavity. A congenital diaphragmatic hernia (CDH) is when the diaphragm does not fully develop and as a result the organs in the abdomen are able to slip up into the chest while the baby is in the womb. When this happens, the organs compress the lungs and they do not fully develop. As a result, depending on the severity of the lung compression the newborn baby with CDH can have problems breathing even after the organs are put back into the abdomen.

How is CDH diagnosed?

Given the improvements in prenatal care and imaging, many times CDH is diagnosed prenatally, before the baby is born. When the diagnosis of CDH is made, measurements can be taken by ultrasound or MRI to attempt to grade the severity of the CDH. However, these measurements are not always absolute and should be interpreted with caution by an expert in the management of CDH. For reasons that aren’t entirely clear, 85% of cases occur on the left side.

What is the outcome for a child with CDH?

Unfortunately, not all babies with CDH survive. Most experts quote the expected survival for all babies with CDH to be around 70-80%. For those babies that survive, they can have long-term problems with breathing, recurrences of the hernia, and feeding/nutrition problems. Therefore, it is important that these babies have access to multiple Pediatric Specialists even after they have left the NICU.

How is a CDH repaired surgically?

Most commonly, CDH is fixed through the abdomen using an incision just below the rib cage. Depending on the size of the hole the surgeon may be able to stitch the hole closed using a primary repair, or, when the defect is too large, using a piece of mesh to patch the hole closed. At HCA Midwest Health, we believe in using the baby’s own, healthy tissue to close the hole to reduce the chance of the hernia coming back. Therefore, we use a muscle from the baby’s abdomen to close the hole of larger defects. In babies that have well-developed lungs and are more stable, we can offer a minimally invasive approach to repair the hernia. In this case, small incisions are made on the chest wall and the hernia can be fixed this way.

What is omphalocele?

Omphalocele is a birth defect in which organs that are normally inside the body develop on the outside, instead, because of an opening near the umbilical cord.

The condition can range in severity, from mild to catastrophic, but typically is larger defect and more dangerous than gastroschisis.

A small-type omphalocele involves only a small piece of the intestine poking through a hole in the abdomen. A large-type of the condition occurs when several of the major organs, such as the intestines, liver, spleen, testes and ovaries, appear outside the body.

Omphalocele can be diagnosed through ultrasound during pregnancy, but not until after the first trimester. The cause of the defect is not known.

What should I know about a baby with gastrointestinal tract birth defects?

Gastrointestinal tract birth defects occur in anywhere from 1 to 10,000 to in 32,000 births. These birth defects are often noticed at birth, or symptoms might not appear until a short while after birth. Regardless, the baby requires immediate medical care for these potentially dangerous malformations.

You should be aware of any symptoms your baby is having and bring them to the doctor immediately if you suspect they may have a gastrointestinal tract birth defect. A baby with these birth defects might require surgery or a transplant. It is important that you act quickly because many gastrointestinal tract birth defects can get dangerous if not treated.

Some gastrointestinal birth defects are more likely to occur in babies with other birth defects. Diaphragmatic hernias result in the protrusion of several organs into the space of the lungs. This usually occurs alongside under-formed lungs and heart deformities.