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.
Abstract:
Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties. Three care levels for fetal therapy centers are proposed to match the anticipated care complexity, with appropriate resources to achieve an optimal outcome at an institutional and regional level. A level I fetal therapy center should be capable of offering fetal interventions that may be associated with obstetric risks of preterm birth or membrane rupture but that would be very unlikely to require maternal medical subspecialty or intensive care, with neonatal risks not exceeding those of moderate prematurity. A level II center should have the incremental capacity to provide maternal intensive care and to manage extreme neonatal prematurity. A level III therapy center should offer the full range of fetal interventions (including open fetal surgery) and be able manage any of the associated maternal complications and comorbidities, as well as have access to neonatal and pediatric surgical intervention including indicated surgery for neonates with congenital anomalies.
More Related Videos
Related Concept Videos
Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
Restorative Care
Teratogenicity
Traditional Level Of Health Care System
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...


