Fetal Care Quality and Patient Safety

Hearing that your baby has a prenatal (before birth) diagnosis that could affect their health can make you nervous. The best way to calm your nerves is to find a fetal center that can provide the best care for your baby and you. The Colorado Fetal Care Center at Children’s Hospital Colorado is that center.

Here, every provider involved in your baby’s care works toward one goal: the best possible outcome for you and your baby. That’s why we track and report our outcomes (success rates) and patient safety data. We want to know that we’re achieving the best results possible and that we have processes in place to constantly improve our care. We want you to know that, as well.

We compare our outcomes to national averages and other top fetal centers in the country. We share this information publicly so you have a clear view of our capabilities and the peace of mind that comes with it.

As one of the few truly comprehensive fetal care centers in the country, we treat virtually all fetal anomalies — even the very rare. And what’s even more important than the variety of conditions we treat is our rate of success.

Why do outcomes and transparency matter?

Fetal anomalies are often serious conditions that require a specific level of experience and training. Families sometimes have to travel for the right care. If your child has a prenatal diagnosis, you want the best possible care for them. But it can be hard to know where to find that care. While many fetal centers track their outcomes, they don’t all report them publicly.

We believe that you should know our outcomes before you make decisions about your baby’s care. We’re proud of our outcomes and how they compare to other fetal centers, and we’re motivated to constantly improve them. We share them with you because we believe they will give you greater peace of mind when seeking care — and because it’s the right thing to do.

Our delivery and surgery volumes

A key measure of a successful fetal center is volume, which is the total number of surgeries, imaging tests, procedures and deliveries the center performs. Higher volume means providers have more experience performing certain procedures. Research shows that more experience correlates with better outcomes, such as higher survival rate and fewer complications.

This is particularly important for rare fetal anomalies. Having higher volumes indicates that we regularly treat patients with rare conditions that other fetal centers might only see once or twice a year.

As our volumes and outcomes show, the rare is common here.

Our delivery volumes

As one of just a few freestanding children’s hospitals in the country with a dedicated labor and delivery unit, Children’s Colorado offers a single, comfortable space where you can receive care before, during and after delivery. This is one of the many reasons so many parents with high-risk deliveries choose us.

What we measure:

We track our total deliveries and deliveries by condition. Only moms carrying a baby with a fetal condition deliver at our Center.

What it means:

We have a level of expertise that only exists with a team that specializes in fetal care, and only fetal care. The babies and families we care for have complex conditions and they need a highly specialized and trained care team. Our volumes show that our care team is just that.

Our surgery volumes

We provide many surgical options from minimally invasive procedures to open fetal surgery.

What we measure:

Our total volume of surgeries for the life of our Center and type of surgery for the past year.

What it means:

Research shows that greater volumes lead to better outcomes. Our fetal surgeons and multidisciplinary team have experience and training in all fetal surgeries. If your baby needs surgery, before or after birth, you want one of the most experienced fetal surgical teams in the country, and you will find that at the Colorado Fetal Care Center.

Our fetal imaging test volumes

Our team of specially trained fetal radiologists, fetal cardiologists, fetal sonographers and maternal fetal medicine doctors provide fetal ultrasounds, fetal MRIs and fetal echocardiograms.

What we measure:

Our total number of fetal imaging tests, including ultrasounds, fetal MRIs and fetal echocardiograms in the history of our Center.

What it means:

Our fetal imaging technologists, fetal radiologists and maternal fetal medicine doctors see thousands of images a year and focus only on prenatal (before birth) diagnoses. They have a trained eye that only experience can bring, which means you get the most accurate diagnosis.

Our twin-to-twin transfusion syndrome outcomes

Twin-to-twin transfusion syndrome (TTTS) is a serious and rare condition in identical twins who share a placenta. An imbalance in circulation of fluid and blood can create severe complications in twins. We treat the most severe and complex cases of TTTS that other fetal centers might not treat at all.

What we measure:

We track survival rates for one and both twins in TTTS pregnancies. A number of factors impact survival, including severity of the condition, when it was diagnosed, risk of prematurity and the presence of selective fetal growth restriction.

The following table shows our survival rates compared to the Solomon Group, an industry benchmark that we compare ourselves to. The Solomon Group was part of a clinical trial to establish expected outcomes for TTTS pregnancies that require selective fetoscopic laser photocoagulation, and advanced surgical treatment.

Twin-to-twin transfusion survival rates (Jan. 2012 to June 2020)

	Solomon Group – 137 women, 274 fetuses Higher is better	Colorado Fetal Care Center – 284 women, 568 fetuses Higher is better
Overall survival	74%	79.9%
At least one surviving neonate	85%	91.9%
Double survival	64%	68%
Neonatal survival	91.6%	94.5%

What it means:

When compared to the Solomon Group, the Colorado Fetal Care Center has higher survival rates for one or both twins. We achieve these survival rates even though we treat the most severe cases of TTTS.

Our myelomeningocele outcomes

Myelomeningocele (MMC) is a serious form of spina bifida, a birth defect of the spine and spinal cord. MMC occurs when the baby’s spine, spinal cord and spinal canal don’t close properly. We often treat MMC with open fetal surgery, which can reduce the need for a shunt and improve movement for your baby.

What we measure:

We measure the shunt rate, which is how often a baby with MMC will need a shunt at some point to help drain excess spinal fluid from the brain. A shunt increases the chances for further complications in the future, so the lower the rate the better. We compare our shunt rate to a national study (MOMS).

We track the percentage of patients who have complete reversal or improvement of hindbrain herniation, which occurs when the brain stem is squeezed into the spine and causes injury. Our team also reports the percentage of patients who deliver in their home hospital and the total number of fetal surgeries.

Shunt rate (Jan. 2012 to June 2020)

Ventricle size	MOMS shunt rate Lower is better	Colorado Fetal Care Center shunt rate Lower is better
<10mm	20%	15.4%
10-15mm	45%	34.1%
>15mm	79%	90%

What it means:

When compared to the outcomes of a national study on surgical repair of MMC, we had lower shunt rates for babies with ventricles smaller than 15 mm. This reduces the risk for future complications and means the baby doesn’t need a shunt placement operation.

A primary goal of prenatal surgery for MMC is to reverse hindbrain herniation, which can injure the spine. Two weeks after surgery, 74% of our patients saw complete reversal or improvement of hindbrain herniation, which is an outstanding rate of reversal and above the rate for other patients in the MOMS study.

Another goal of prenatal surgery for MMC is to get the unborn baby healthy enough so that mom can deliver at her home hospital. This cuts down on travel and stress and allows them to stay close to family during this special time. Finally, our total number of MMC surgeries shows our team’s experience in caring for MMC. Research shows that more experience leads to better outcomes for babies.

Our congenital diaphragmatic hernia outcomes

Congenital diaphragmatic hernia (CDH) is a birth defect that occurs when a baby’s diaphragm doesn’t form correctly creating an opening between the chest and abdominal cavities. This allows abdominal organs to enter the chest cavity and prevent lung development.

We treat CDH both before and after birth depending on what is best for each baby.

What we measure:

We measure overall volume of patients with CDH, survival rate and percentage of patients who deliver their babies at Children’s Colorado when clinically necessary.

What it means:

At the Colorado Fetal Care Center and our Neonatal Intensive Care Unit, we have some of the highest volumes and one of the highest survival rates for CDH in the country. We’re also helping more moms deliver at their home hospital when possible by providing care before birth and working closely with their primary doctors. We are delivering some of the best results for the most severe CDH cases and limiting disruption for families with less severe cases.

At the Colorado Fetal Care Center, our renowned Fetal Cardiology Program cares for babies with a wide range of heart problems, including congenital heart defects (CHDs), cardiomyopathies and arrhythmias. Heart conditions represent the largest percentage of our deliveries in the Colorado Fetal Care Center.

When a structural or heart rhythm problem is detected prenatally, our fetal care team provides an accurate diagnosis and an individualized care plan just for your baby. Treating certain heart conditions before birth can improve long-term outcomes. As soon as your baby is born, colleagues in our nationally-ranked Heart Institute are equipped to provide all the care your baby may need, from surgery to cardiac catheterization to device placement and beyond.

When it comes to the most risky and complex heart surgeries, known as a STAT 5 surgery, our fetal cardiology program out-performs the national average.

See our Heart Institute’s full volumes and exceptional outcomes in cardiac surgery, heart transplantation and overall quality and patient safety.

Patient experience at the Colorado Fetal Care Center

Our goal is to provide excellent care to babies and their families throughout their stay. We measure that through patient experience surveys with our families. For 2019, families rated their experience on a scale of 0 to 10, with 10 being the best experience. We receive feedback on our inpatient experience, which is our high-risk pregnancy labor and deliver unity, and our outpatient experience, which is when we see moms for consultations, imaging tests and other services.

We measure our outcomes on a continual basis to ensure we’re providing the best possible care while meeting or exceeding the high standards we set for ourselves. We are committed to sharing those outcomes with you and providing any additional helpful information. Visit the resources below to learn even more.

• Learn how to plan for your visit to the Colorado Fetal Care Center.
• Read frequently asked questions about the Colorado Fetal Care Center.
• Learn more about our nationally-ranked Heart Institute.
• The Fetal Health Foundation provides a wealth of resources for families with a prenatal diagnosis.

Learn more about choosing a fetal care center: