Children's Hospital Colorado

Maternal Fetal Research

Fetal surgeon Dr. Liechty takes on congenital anomalies at Children's Hospital Colorado.
Research article

Current research has identified what causes a congenital diaphragmatic hernia. After searching for a solution, surgeons discovered a very small balloon called fetoscopic tracheal balloon occlusion. Learn how this helps in the growth of lungs.


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.

LEADER in EXIT Procedure for Treatment of Complex Fetal Heart Block
1st to use Nifedipine for TTTS
OVER $25 Million in Research Funding

Clinical research

Indications for delivery for twin-twin transfusion after SFLP
Purpose: Multicenter trial including NAFTNet members to collect information about timing and indications for delivery following the Selective Fetoscopic Laser Photocoagulation (SFLP) procedure.
Primary investigator: Dr. Michael V. Zaretsky

Assessment of fetal cardiac function in twin-to-twin transfusion syndrome
Purpose: To learn more about how the heart works in twins who have been diagnosed with twin-to-twin transfusion syndrome as evaluated by a fetal cardiologist.
Primary investigator: Dr. Lisa Howley

Echocardiographic criteria for timing of congenital diaphragmatic hernia repair
Purpose: To evaluate the standardization of the decision to perform CDH repair using echocardiography.
Primary investigator: Dr. Jason Gien
Partnering research institute: Cincinnati Children's Hospital

Heart Sounds at Home: prospective maternal surveillance of SSA positive pregnancies using a handheld fetal heart rate monitor
Purpose: To determine whether the use of fetal heart rate monitors in the ambulatory setting will successfully detect the earliest onset of antibody-mediated AV heart block.
Primary investigator: Dr. Bettina Cuneo

Prospective identification of long QT syndrome in fetal life
Purpose: To collect medical information about the type of Long QT syndrome identified, EKG and genetic testing after the affected baby is born. Also to look for and identify long QT syndrome in babies before they are born. Identifying long QT syndrome (a heart rhythm disorder) before birth could prevent some stillbirths, sudden infant death syndrome and childhood deaths.
Primary investigator: Dr. Bettina Cuneo

International Fetal Cardiac Registry
Purpose: To gather clinical information about pregnant women who are referred to Children's Hospital Colorado for echocardiograms as well as prenatal and postnatal information about the baby. 
Primary investigator: Dr. Lisa Howley

Basic science research

Purpose: Congenital bladder outlet obstruction is a devastating condition that can lead to severe morbidity in childhood. The high bladder pressure and ensuing anhydramnios can lead to kidney failure requiring dialysis or transplant, irreversible bladder scarring, urinary incontinence, lung hypoplasia and limb deformities. The current method of treatment for bladder outlet obstruction in utero focuses on creating a shunt between the fetal bladder and the amniotic cavity. This decompresses the bladder and increases the fluid volume around the fetus. This procedure is usually done with the Harrison shunt, a small pig-tailed catheter placed under ultrasound or fetoscopic guidance. This treatment is known to have certain limitations, as the shunt can be dislodged, sometimes necessitating multiple shunts per pregnancy.

The research group is using an ovine model of bladder outlet obstruction to test a new type of vesicoamniotic shunt. The research group believes the characteristics of this new shunt will mean a reduced chance of displacement and will allow urine to flow out of the obstructed bladder at lower pressure than the current shunt.

The new shunt has been successfully tested in a pilot study. The project has now moved into the comparative phase; testing the new shunt against the Harrison shunt in a twin pregnancy ovine model.

Primary investigator: Dr. Nicholas Behrendt

Purpose: Postnatal survival depends upon the ability of the pulmonary circulation to undergo rapid and dramatic developmental changes in blood flow due to vasodilation during the first minutes after birth. Failure of the pulmonary circulation to successfully achieve or sustain this vasodilation causes severe hypoxemia in cardiopulmonary disorders that constitute persistent pulmonary hypertension (PPHN). Currently, Dr. Dodson’s work focuses on understanding the relationship between the altered biomechanics of blood flow in the pulmonary arteries to the changes that occur within the endothelial cells and extracellular matrix of the vascular wall. Dr. Dodson’s expertise in studying the pathobiology of PPHN is to develop novel therapeutic targets in the treatment of PPHN in newborns.

Primary investigator: Dr. Jason Gien

Purpose: Heart attacks, also known as a myocardial infarction, are sustained by more than 1 million Americans per year. Procedures such as angioplasty or coronary artery bypass surgery are successful in large subsets of patients, but there is still a subset of patients where there is not an adequate treatment. Myocardial infarctions in adults cause scar formation of the heart muscle. This is the result of collagen accumulating at the site of the injury, causing hardening of the tissue of the heart muscle. However, unlike in adults, the fetus is able to regenerate the heart muscle following a myocardial infarction resulting in restoration of normal heart function.

Fetal wounds also tend to heal without a scar and with limited inflammation. Dr. Liechty's work focuses on understanding the cellular mechanisms that play key roles into the ability for the fetus to regenerate the heart. Debunking these cellular mechanisms that play key roles will aid in the development of potential treatments to prevent heart failure following a heart attack in the adult.

Primary investigator: Dr. Kenneth Liechty

Reference materials: Mammalian Fetal Cardiac Regeneration After Myocardial Infarction Is Associated With Differential Gene Expression Compared With the Adult (.pdf)

Purpose: Skin and tendon wounds can be the result of traumas, surgery, burns, elective surgeries or even immobility following an injury. Scar tissue is weaker than normal tissue and can cause impairments to the affected areas of skin or tendon. People with diabetes have particular skin healing impairments due to their condition, which can cause prolonged healing and can even lead to amputation. Interestingly, fetal small skin and tendon wounds heal without scars, and with the restoration of normal skin and tendon architecture.

Large fetal wounds do not tend to heal scarlessly, similar to adults, but small fetal wounds heal without scars. Dr. Liechty's team uses the fetal model to understand the cellular mechanisms differences between fetuses and adults. Understanding the relationship between fetal small wounds and larger wounds will allow for future therapeutic options for adults. Especially understanding the mechanism of inflammation in people with diabetes will lead to improvement in wound healing and offer better therapies to expedite wound healing.

Primary investigator: Dr. Kenneth Liechty

Purpose: Neural tube defects have profound effects not only anatomically, but functionally, emotionally and psychologically. Neural tube defects also place a large financial burden not only on the affected families, but the health care system as well. Although there has been a decrease in neural tube defects, such as spina bifida, with improvements in prenatal care, there is a lack of knowledge of the basic biological mechanisms to develop novel medical treatments to treat these defects.

Currently, spina bifida aperta, which is an open neural tube defect, requires surgery at 24 weeks of gestation to improve postnatal need for shunts and reduce the negative effects of exposed neural elements in utero. However, operation in utero introduces its own risk to the mother and fetus and damage to the neural elements has still occurred. Dr. Marwan's work is focused on understanding the biomechanisms responsible for neural tube closure, which will be a key in developing alternate therapies to treat those affected by neural tube defects. This work also aims to improve surgical methods with alternate biomaterials to either treat the defect at an earlier stage of gestation or act as a therapeutic agent that can treat the defect.

Primary investigator: Dr. Rony Marwan

An international multi-institutional prospective study evaluating the use of home Doppler fetal heart rate monitoring in the detection of fetal heart block in mothers with Sjogren's antibodies.

Primary investigator: Bettina Cuneo, MD

An international prospective study evaluating fetal heart rate in pregnancies where the mother or father has long QT syndrome (LQTS). The purpose is to determine if fetal heart rate can predict which fetus will have LQTS. Visit for more information.

Primary Investigator: Bettina Cuneo, MD

An international study, randomized to compare digoxin with flecainide or sotalol for the treatment of fetal atrial flutter or supraventricular tachycardia.

Primary investigator: Bettina Cuneo, MD

Multidisciplinary prospective study.

Primary investigator: Lisa Howley, MD

Volumes and outcomes

Our goal is for every family to receive optimal, high-value, compassionate healthcare. As a result of our multidisciplinary approach, we are proud to report some of the best outcomes in the nation. Learn more about the Colorado Fetal Care Center, including our latest outcomes.

Children's Colorado in the news

Arvada Press

Castle Rock Couple Recount Newborn’s Tough Road

Debbie and Jennifer Stevenson are grateful to the Colorado Fetal Care Center (CFCC) and the care they received for their son, Eli, who was diagnosed with congenital diaphragmatic hernia (CDH).

The Denver Post

Colorado Fetal Care Center Reunion

The Colorado Fetal Care Center hosted a reunion for several families who have benefitted from their care for conditions including pre- and postnatal intervention for Twin-to-Twin Transfusion Syndrome, spina bifida and congenital diaphragmatic hernia.


Home From Hospital, Twins Spending First Christmas Together

For parents Charise and Mike Walters, this Christmas is one they will always treasure. Twins, Tommy and Emily were born last year, six weeks early; Tommy went home for Christmas, but Emily did not. She was born with congenital diaphragmatic hernia and was given only about a 20 percent chance of survival. She beat the odds and today, both Tommy and Emily are doing well, and will spend their first Christmas together.

Stapleton Front Porch

Children’s Colorado a Top Hospital to Treat Twin-to-Twin Fetal Disease

The expert care team at the Colorado Fetal Care Center helped save identical twins Ciela and Mila, whose parents live in Denver’s Lowry neighborhood. The girls developed twin-to-twin transfusion syndrome while in utero, but today they have no evidence of any complications during pregnancy.