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Care Levels for Fetal Therapy Centers.

Ahmet A Baschat1, Sean B Blackwell, Debnath Chatterjee

  • 1Department of Gynecology & Obstetrics, Johns Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland; the Department of Obstetrics, Gynecology & Reproductive Sciences and the Division of Pediatric General and Thoracic Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; the Department of Anesthesiology, Children's Hospital Colorado/Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado; the Department of Pediatrics & Bioethics, Albany Medical College, Albany, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Pediatric, General, Thoracic and Fetal Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, California; the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, and the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; the Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; the Department of Surgery, Warren Alpert Medical School of Brown University, and Hasbro Children's Hospital, Providence; Rhode Island; the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina; the Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; the Division of Pediatric Cardiology, Department of Clinical Pediatrics, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; the Division of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; the Department of Surgery, Centre for Surgical Research, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; the Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Yale University School of Nursing, Orange, Connecticut; and the Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Obstetrics and Gynecology
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PubMed
Summary
This summary is machine-generated.

Fetal therapy centers require tiered resources to manage risks associated with interventions. Proposed levels I, II, and III ensure appropriate care complexity and optimal maternal and neonatal outcomes.

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Neonatology

Background:

  • Fetal therapies aim to improve outcomes but carry maternal, fetal, and neonatal risks.
  • Managing these risks necessitates specialized infrastructure and resources within fetal therapy centers.
  • Multidisciplinary collaboration is crucial for oversight, monitoring, and managing complications.

Purpose of the Study:

  • To propose a tiered system for classifying fetal therapy centers based on care complexity.
  • To define resource requirements for each center level to optimize outcomes.
  • To guide institutional and regional planning for fetal therapy services.

Main Methods:

  • Development of a three-level classification system (Level I, II, III) for fetal therapy centers.
  • Defining the scope of fetal interventions and associated risks for each level.
  • Outlining necessary maternal, fetal, and neonatal care capabilities and resources for each level.

Main Results:

  • Level I centers manage interventions with risks of preterm birth, unlikely requiring maternal intensive care, with neonatal risks of moderate prematurity.
  • Level II centers provide maternal intensive care and manage extreme neonatal prematurity.
  • Level III centers offer comprehensive fetal interventions, including open fetal surgery, managing complex maternal complications and neonatal surgical needs.

Conclusions:

  • A tiered approach to fetal therapy center designation ensures appropriate resource allocation and expertise.
  • This framework supports standardized, high-quality care for complex fetal conditions.
  • Implementation of these levels can optimize maternal and neonatal outcomes regionally and institutionally.