Children's Hospital Colorado

Colorado Fetal Care Center Healthcare Professional Resources

Advancing fetal care

At the Colorado Fetal Care Center, we’re committed to partnering with providers to improve care for moms and babies and moving the field of fetal care forward.

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Maternal fetal medicine education videos

At Children's Hospital Colorado, we work to improve the health of moms and babies in our care, but also to create maternal fetal provider resources to advance the field across the country and beyond.

When pregnancies don't go according to plan, our maternal fetal medicine experts are here to provide expertise and guidance. In the videos below our providers discuss high-level care for specific conditions that you might not see on a consistent basis.

Fetal myelomeningocele (MMC) repair

Myelomeningocele (MMC) is a type of spina bifida associated with significant health issues, such as hydrocephalus, impaired motor function and bladder and fecal incontinence. Some families may be candidates for prenatal repair for MMC, which can greatly reduce the baby’s need for ventriculoperitoneal shunts and improve overall long-term outcomes.

In this video, fetal and pediatric surgeon Christopher Derderian, MD, compares the benefits, and implications for both fetoscopic and open repair, while addressing associated risks and how recent fetoscopic advancements show promise in reducing the risk of preterm delivery and eliminating the need for C-section deliveries.

Reducing postoperative opiate use after cesarean

Cesarean delivery is one of the most common surgical procedures in the U.S., accounting for 32% of all deliveries. Historically, most care providers have used a multimodal pain management regimen including opioids. But as concerns about opioid use grow, the Colorado Fetal Care Center at Children’s Hospital Colorado is looking into alternative pain management options.

In this video, Michael Zaretsky, MD, and Cristina Wood, MD, discuss recent efforts to limit postoperative opiate use throughout a cesarean delivery, including the use of a wound infusion pump, and implementation of the 2019 Early Recovery After Cesarean guidelines.

Novel non-pharmacologic innovation for improving maternal mental health

According to CDC data published from 36 states in 2022, mental health conditions and substance use are the most common cause of maternal mortality. Postpartum mental health disorders disproportionately affect patients with cesarean delivery, with one-third of patients reporting mental health symptoms after delivery and one in five patients experiencing severe post-operative pain, putting them at high risk for chronic pain and long-term opiate use.

In this video, Cristina Wood, MD, discusses the results from a new intervention: a non-pharmacologic, low-cost, single-session intervention to reduce maternal mental health symptoms and post operative opiate use. The two-part approach involves psychoeducation and a brief exposure to the operating room where patients are walked through all steps of a cesarean delivery from pre- to post-operation.

Consensus statement on anesthesia for maternal-fetal interventions

A wide range of fetal interventions are performed throughout pregnancy, and the anesthetic management of these fetal interventions has evolved over the years. At the Colorado Fetal Care Center, our pediatric and obstetric anesthesiologists make up an integral part of the care team and provide services 24/7. They specialize in caring for mom and baby during a fetal procedure as well as during delivery.

In this video, Debnath Chatterjee, MD, fetal and pediatric anesthesiologist, discusses the development of a national consensus statement on anesthesia for maternal-fetal interventions from a multidisciplinary team of experts. The statement describes the preoperative evaluation and intraoperative anesthetic management, which includes monitoring of both the mother and her fetus, and postoperative care of these patients. In addition, he also discusses the results of the first formal survey of anesthetic techniques and anesthesia staffing models of fetal therapy centers in the North American Fetal Therapy Network, or NAFTNet.

Pain management during labor

There are many questions about pain management during labor, and there are often misconceptions. Labor is a unique experience for each mom, and at the Colorado Fetal Care Center, we support our patients’ pain management goals. Our anesthesiology team is a vital part of making our patients comfortable while keeping them and their baby safe during delivery.

In this video, Cristina Wood, MD, Medical Director of Obstetric Anesthesiology, and Michael Zaretsky, MD, Co-Medical Director of the Colorado Fetal Care Center, cover everything from labor progression to COVID-19 and more. They discuss some of the common misconceptions and questions about labor epidurals, including the benefits of medicated and natural births, risks associated with epidurals, breastfeeding after epidurals and more. They dispel many myths and share our approach to common concerns and questions.

STOP BLOQ Study: surveillance and treatment to prevent fetal AVB

Fetal third-degree AV block identified in the second trimester in an otherwise normally developing heart is almost universally associated with maternal anti-Ro autoantibodies. The burden of third-degree AV block includes a perinatal mortality of 18%, which exceeds that for all non-cardiac congenital anomalies combined.

In this video, Bettina Cuneo, MD, former Director of Fetal Cardiology and Fetal Cardiac Telemedicine, describes a new five-year, NIH-funded study called the STOP BLOQ Study, which includes 37 participating centers. Study participants will include moms with a high level of anti-Ro/SSA antibodies in their blood. The purpose of the study is to learn whether they can identify an abnormal heartbeat by listening to their fetus’ heartbeat three times a day at home using a small Doppler device. Researchers will also study whether urgent treatment of an abnormal heartbeat can restore normal rhythm in those diagnosed with second-degree heart block.

How fetal tele-echo can improve healthcare disparities for pregnant women with fetal cardiac anomalies

A recent study conducted by the Fetal Heart Society found that transposition of the great vessels during pregnancy was detected at a much lower rate in women who lived in rural areas compared to women who lived in urban areas. A specialized ultrasound called a fetal echocardiogram is used to detect this cardiac defect before birth, and maternal fetal medicine specialists or fetal cardiologists must interpret the results. However, these specialists are rare in rural areas.

In this video, Bettina Cuneo, MD, former Director of Fetal Cardiology and Fetal Cardiac Telemedicine, explains the importance of detecting fetal cardiac defects. She discusses the fetal tele-echo site established in Grand Junction, Colorado five years ago and the success they’ve had with the program. She also reviews recent expansions of rural tele-echo and tele-maternal-fetal medicine sites in Colorado.

Advanced cardiac monitoring for the at-risk fetus at the Colorado Fetal Care Center

Fetal heart rate monitoring is the obstetrical mainstay of assessing fetal well-being of a high-risk fetus. The sophisticated fetal heart rate monitoring technology that has existed for 25 years is fetal magnetocardiography (fMCG) which uses a device called large and expensive superconducting quantum interference device (SQUID) biomagnetometer to record the magnetic analog of the fetal ECG.

In this video, Bettina Cuneo, MD, former Director of Fetal Cardiology and Fetal Cardiac Telemedicine, discusses a new, smaller and less expensive biomagnetometer called the optically pumped magnetometer (OPM). The OPM provides the same in-depth fetal heart rate monitoring from 18 weeks of gestation to full-term. Starting in 2021, it will be available at the labor and delivery unit at the Colorado Fetal Care Center. The Center will be the only fetal care center in the country to use fMCG in the evaluation and management of high-risk fetuses in a hospital setting. Dr. Cuneo discusses the various ways in which we will use the new technology, which includes the evaluation of fetuses at risk for still-birth.

Too fast too slow: An arrhythmia case study

In this video, Bettina Cuneo, MD, former Director of Fetal Cardiology and Fetal Cardiac Telemedicine, presents a unique case study on a fetus who initially presented with a normal cardiac rhythm but was found to have a very severe defect. This fetus was the first of its kind to be treated successfully in utero and undergo a full-term delivery.

The baby was initially diagnosed with supraventricular tachycardia and treated for this condition at another institution, but the fetus did not respond. So, the mother was sent to Children’s Colorado for a second opinion and was instead diagnosed with ventricular tachycardia (VT). Previous fluctuations in heart rate and a new diagnosis of VT suggested long QT syndrome (LQTS). Watch the video to learn more about our diagnostic and treatment approach.

Gene editing technology: CRISPR

CRISPR/Cas9 is a molecular tool that scientists have adapted to modify DNA. Researchers first identified it in bacteria as a clustered regularly interspaced short palindromic repeat (CRISPR) and are studying it as a potential therapeutic for genetic diseases.

In this video, Medical Director of the Colorado Fetal Care Center at Children’s Colorado, Michael Zaretsky, MD, and Sean McGrath, PhD, from the University of Colorado Gates Center for Regenerative Medicine, discuss CRISPR. Dr. McGrath reviews what CRISPR is, how it works, its unique characteristics and associated safety concerns. Dr. Zaretsky discusses research that is being conducted at the Colorado Fetal Care Center in collaboration with researchers who are experts in the field. This research involves investigating the potential of CRISPR as a fetal therapy to correct mutations before delivery to improve outcomes for cystic fibrosis.

Postoperative pain management for caesarean deliveries: reducing narcotic usage

Mental health issues, including drug overdose, are among the leading causes of maternal morbidity both nationally, and here in Colorado. So minimizing opiate use for postoperative pain management in new moms is essential for their overall health and well-being.

In this video, Cristina Wood, MD, Medical Director of Obstetric Anesthesiology at our Colorado Fetal Care Center, discusses the innovative tactics her team uses to reduce postoperative opiate use while keeping moms comfortable during caesarean deliveries. Dr. Wood highlights what her research shows about how these strategies impact both postoperative opiate utilization and its associated side effects.  

Congenital diaphragmatic hernia diagnosis and treatment

Approximately one in 3,000 pregnancies are affected by a congenital diaphragmatic hernia (CDH), a fetal abnormality where the fetus' abdominal contents herniate into the thorax, resulting in pulmonary hyperplasia and pulmonary hypertension.

In this video, Michael Zaretsky, MD, Medical Director of the Colorado Fetal Care Center at Children's Colorado, outlines CDH diagnosis guidelines, such as the measures maternal fetal medicine specialists should take in evaluating and making a CDH diagnosis. Dr. Zaretsky also discusses CDH treatment protocol for certain symptoms and situations.

Fetoscopic endoluminal tracheal occlusion (FETO) procedure and research

Fetoscopic endoluminal tracheal occlusion (FETO) is an experimental treatment that some in the medical community hypothesize is an effective treatment for moderate to severe congenital diaphragmatic hernia (CDH). Researchers started studying the effectiveness of tracheal occlusion nearly 20 years ago, but early studies found that it was no more effective than conventional treatments for CDH and that it was associated with premature delivery. Research at that time was also not conducted with patients in the severest category of CDH. Current research on FETO, including studies performed at Children’s Colorado, focuses on patients with moderate to severe CDH by strict criteria.

In the following video, Dr. Zaretsky details the history of the FETO procedure, explains the procedure itself and discusses recent research findings. Watch the following video to learn about the latest in FETO research and our approach to exploring FETO with families.

Intrauterine growth restriction (IUGR) diagnosis and treatment

Intrauterine growth restriction (IUGR) is a fetus that measures small for its gestational age in pregnancy. IUGR is also known as fetal growth restriction and “small for gestational age,” and commonly refers to a fetal weight below the 10th percentile for gestational age. Early identification of IUGR is important as it carries risks for both mom and baby.

In the following video, Henry Galan, MD, professor at the University of Colorado School of Medicine and maternal-fetal medicine physician at the Colorado Fetal Care Center, discusses causes of IUGR, diagnostic and assessment techniques, treatment options and more.

Baby Care Plan: When and How to Use It

Most babies who have a prenatal diagnosis will need follow-up care or a consultation after they’re born. That’s why we created the Baby Care Plan, which is a tool families and referring providers can use to plan and schedule all the necessary care their baby will need after delivery.

In this video, Shelly Whitmore, manager of physician relations, and Nicholas Behrendt, MD, a maternal fetal medicine specialist at the Colorado Fetal Care Center, describes what the Infant Action Plan is and how providers can use this resource with their patients. Together, they explain the advantages of using this tool and provide an example of how having a plan in place is invaluable.

Prenatal Genetic Screening for Chromosomal Abnormalities

Prenatal genetic screening can provide insight into possible fetal chromosomal abnormalities, also called aneuploidies. These abnormalities signal that a baby might be at risk conditions such as Down syndrome (Trisomy 21), Edwards syndrome (Trisomy 18) and Patau syndrome (Trisomy 13). In the following video, Kestutis Micke, a genetic counselor with the Colorado Fetal Care Center at Children’s Colorado, provides an overview of prenatal genetic screening. He explains that while prenatal genetic screening doesn’t provide an exact diagnosis, it allows parents to make informed decisions about their pregnancy. He also discusses new, minimally invasive procedures that are improving accuracy and reducing the impact on patients.

Indications and timing for delivery after laser ablation for twin-to-twin transfusion syndrome (TTTS)

While laser ablation can reduce complications and improve survival in pregnancies with twin-to-twin transfusion syndrome (TTTS), prematurity is still a primary cause of morbidity and mortality in patients with TTTS. In the following video, Dr. Zaretsky discusses findings from a study on the factors that influence premature delivery in babies with TTTS. You will learn about the average time to delivery following laser ablation as well as the most common maternal and fetal indicators for premature delivery.