Children's Hospital Colorado

Maternal and Fetal Medicine Research at the Colorado Fetal Care Center

Our research at the Colorado Fetal Care Center is driven by our belief that all children, even those not yet born, deserve the best chance at a brighter future. Through collaboration in ongoing multicenter trials, we're able to:

  • Offer some of the most innovative fetal therapies available today
  • Continually advance the standard of care for maternal and fetal medicine
  • Develop new therapies across the perinatal spectrum, from obstetrics to neonatology

Our research, in partnership with the University of Colorado School of Medicine, allows us to continually advance the standard of care for and treatments of infants, expecting mothers and high-risk pregnancies.

1ST Team to perform EXIT to pacemaker for fetal heart block
$25M+ In active research funding
1M Square feet of research space
Dr. Dempsey talking with a pregnant mother.
Research article

Fetal diagnoses are stressful, and the stress can affect the baby. Our psychologist is working to improve outcomes by teaching mothers how to breathe.

Clinical trial

Researchers at Children’s Hospital Colorado are investigating the safety and feasibility of providing regenerative therapy for a rare congenital heart defect called hypoplastic left heart syndrome (HLHS).

Diagnosis
Infants diagnosed with hypoplastic left heart syndrome in utero
Age
Stem cell collection at birth; Glenn procedure at 3-6 months old

Maternal and fetal medicine advancements

We're known around the world for groundbreaking innovations in fetal care research that are revolutionizing the care and treatment of both mother and child in high-risk pregnancies. Some of our team's most significant advancements include:

Revolutionizing myelomeningocele (MMC) treatment and repair

Our fetal surgeons are advancing and innovating prenatal treatment and repair for fetuses with myelomeningocele. In our efforts to improve MMC patients' quality of life, reduce complications and obtain better outcomes, our researchers have made several significant contributions, innovating the way fetal surgeons approach MMC. These efforts include:

  • Evaluated long-term flow patterns in the ductus arteriosus before, during and after fetal MMC repair to potentially reduce the incidence and/or severity of ductus arteriosus (DA) constriction and fetal cardiac dysfunction during open fetal surgery.
  • In an effort to reduce the need for shunting, our fetal surgeons became the first in the world to use 3D printing to prefabricate MMC patches before surgery.

Improving outcomes for fetuses twin-to-twin (TTTS) transfusion syndrome

We are one of the country's highest volume fetal centers treating twin-twin transfusion syndrome. Our multidisciplinary team of maternal fetal medicine specialists, specialized physicians, fetal cardiologists and pediatric fetal surgeons collaborate to improve outcomes for laser photocoagulation, increase survival and decrease prematurity for babies with TTTS.

In an effort to guide future improvements in patient care, Michael Zaretsky, MD, collaborates with the North American Fetal Therapy Network (NAFTN) in managing a national registry of the complications and outcomes of monochorionic twin pregnancies.

Optimizing the health and delivery of babies with congenital heart disease (CHD)

Our work places us at the forefront of fetal cardiology and makes us leaders in caring for new lives. The Colorado Fetal Care Center team completed the first-ever Ex Utero Intrapartum Treatment (EXIT) to ventricular pacing procedure and continues to lead in innovative ways:

  • We are pioneering new techniques in regenerative medicine, including engineering a heart patch made of an infant's own tissue to improve outcomes for babies with hypoplastic left heart syndrome (HLHS). Using amniotic fluid collected at delivery, our team aims to create beating heart cells that can be used for future surgical repairs.
  • In the Heart Sounds at Home clinical trial, our researchers were the first to initiate fetal home doppler monitoring in the detection of fetal heart block for positive anti-SSA mothers.
  • Bettina Cuneo, MD, participated in a multicenter study aiming to increase parental education and improve transparency between clinical teams and parents. Using a series of questions developed by the Pediatric Congenital Heart Association (PCHA), we provide institution-specific answers for families regarding pediatric cardiac intervention outcomes, as well as short- and long-term expectations for neonates and infants with CHD.

Pioneering new technologies and treatments for babies with congenital diaphragmatic hernia (CDH)

Our Colorado Fetal Care Center is a national referral site for CDH, as the neonates with CDH who are discharged from our NICU have some of the best outcomes in the nation.

  • Our fetal surgeons conducted a clinical trial to improve lung growth for fetuses with CDH using fetoscopic tracheal balloon occlusion (FETO). We consistently see improved outcomes for patients with severe left-sided CDH.
  • In a multi-center study, our researchers standardized prenatal assessment of risk-stratification for fetuses with CDH.
Dr. Ken Liechty of the Colorado Fetal Care Center at Children's Hospital Colorado.
"Every day is a good day on the job where parents are trusting me to take care of their most prized possession."
Kenneth Liechty, MD

Maternal fetal medicine professional education videos

In these short videos, our experts offer insights into the advanced treatments and specialized clinical care they provide at our hospital.

What our maternal and fetal medicine research means for babies and expecting moms managing high-risk pregnancies

Our research at the Colorado Fetal Care Center aims to improve outcomes for babies with the highest-risk and rare fetal conditions, as well as ensuring mothers experience fewer complications from fetal therapies, labor and delivery.

At the heart of our research is a focus on each child's long-term quality of life, which influences everything we do and results in:

  • A better standard of living for our patients – babies, twins, moms and multiples
  • Improved care for the fetus
  • More innovative treatment options
  • Fewer complications for mothers from fetal therapies, labor and delivery

Our research means that here, you'll find expertise for the rarest conditions, and a multidisciplinary team dedicated to improving the outlook for our unborn patients and the mothers who carry them.

Bringing together the brightest minds to innovate HLHS treatments

As one of only five centers in the country – and the only center in the region – participating in Mayo Clinic's HLHS Consortium, we are leading the way to find solutions for patients with HLHS. Through our Fetal Cardiology Program, pregnant women with a fetal HLHS diagnosis have the opportunity to participate in groundbreaking clinical trials studying the use of cell-based regenerative therapy to transform the lives of their children born with HLHS.

Reducing the complications of mothers managing high-risk pregnancies

Our fetal surgery team constantly strives to reduce complications; following the groundbreaking Management of Myelomeningocele Study (MOMS), our fetal surgeons developed a modified hysterotomy closure technique that may reduce obstetric morbidity associated with prenatal MMC repair and other open fetal surgeries.

Timing and indications for delivery following laser ablation for twin-to-twin transfusion syndrome

Laser photocoagulation can improve survival and reduce complications for twin pregnancies affected by twin-to-twin transfusion syndrome (TTTS), but prematurity remains a major source of neonatal morbidity and mortality for these patients. To better understand the indications and factors that influence premature delivery after laser ablation in babies facing TTTS, Michael Zaretsky, MD, and his team collected delivery information from 847 patients from 11 centers within the North American Fetal Therapy Network. This study determined that premature delivery, which on average occurs 10 weeks after laser photocoagulation and at 31 to 32 weeks gestational age, is primarily the result of spontaneous labor, preterm premature rupture of membranes and the status of the donor fetus. Researchers also found that placental abruption was a frequent complication causing early delivery.

Read the article “North American Fetal Therapy Network: Timing of and Indications for Delivery Following Laser Ablation for Twin-Twin Transfusion Syndrome”

Evaluating fetal telecardiology in a medically underserved area

Initiated in 2015, our fetal telecardiology program serves families in Grand Junction, Colo., 243 miles and two mountain passes away from our hospital on Anschutz Medical Campus. After 37 months and 455 examinations, we evaluated the program on five domains: education of sonographers before initiation; process and efficiency; patient satisfaction; economic effect; and accuracy. The results are clear: The program is feasible, empowers local care providers, correctly risk stratifies fetuses with congenital heart disease, provides strong economic advantages and the benefit of timely, face-to-face consultation without travel.

Read the study “Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiology.”

Mothers with long QT syndrome face increased risk for fetal death

Long QT syndrome (LQTS) is a genetic disorder of cardiac ion channels that carries a risk of sudden death for affected individuals, including fetuses. Led by Children’s Colorado fetal cardiologist Bettina Cuneo, MD, this multi-center, international study sought to determine the risk of fetal death in fetuses whose mother or father carried the LQTS gene mutation. In a case series of 148 pregnancies from 103 families, recruited from 11 international centers in nine countries, researchers demonstrated that families with LQTS are at increased risk of stillbirth compared to the population that did not carry this gene mutation.

Read the study “Mothers with long QT syndrome are at increased risk for fetal death: Findings from a multicenter international study.”

Outcomes for extended BMI criteria in fetal myelomeningocele repair

In utero repair for spina bifida has become an accepted therapy to decrease the rate of ventriculoperitoneal shunting and improve neurologic function in select cases of fetal myelomeningocele (MMC). The Management of Myelomeningocele Study, or MOMS trial, excluded patients with a BMI above 35 due to concerns for increased maternal complications and preterm delivery. This retrospective review evaluated outcomes associated with extending maternal BMI to 40. In 11 patients with an average BMI of 37, we did not observe any adverse maternal outcomes; however, gestational age at delivery was two weeks earlier on average, compared to the MOMS trial.

Read the study “MOMS Plus: Single-Institution Review of Outcomes for Extended BMI Criteria for Open Fetal Repair of Myelomeningocele.”

Abnormal ventricular contractility in fetuses with estimated weight less than the tenth centile

In a retrospective study of 50 fetuses with an estimated fetal weight in less than the tenth percentile, we found high rates of abnormal ventricular contractility — irrespective of the Doppler findings of the pulsatility index of the umbilical artery or cerebroplacental ratio. These findings demonstrate that these fetuses may be considered for assessment of ventricular contractility even when corresponding Doppler findings are normal.

Read the study “Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile.”

Indomethacin dosing and constriction of the ductus arteriosus

The use of perioperative tocolytic agents such as indomethacin are imperative in preventing preterm labor. However, indomethacin can also cause ductus arteriosus (DA) constriction. This retrospective observational case series of 42 pregnant mothers who underwent open fetal myelomeningocele repair observed ductus arteriosus constriction in all fetuses receiving two doses of indomethacin and in 71.4% receiving one dose. These fetuses were all between 23-26 weeks gestation. Historically, clinicians felt this effect on the ductus was dependent on gestational age with a greater effect occurring later rather than earlier in gestation. Perhaps the combination of fetal surgery, anesthesia and magnesium sulfate potentiated the effect of indomethacin on the ductus arteriosus. One dose of indomethacin and greater magnesium sulfate dosing was associated with reduced DA constriction.

Read the study “Indomethacin dosing and constriction of the ductus arteriosus during open fetal surgery for myelomeningocele repair.”

Contact the Colorado Fetal Care Center at 1-855-413-3825 or fetalcare@childrenscolorado.org.

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