Maternal and Fetal Medicine Research at the Colorado Fetal Care Center

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.”