Fetal Care
Yale Fetal Care Center Experience
Yale New Haven Hospital Children’s Hospital
Yale School of Medicine
Congenital Anomalies
Significance of Congenital Abnormalities
Significance of Congenital Abnormalities
The Evolution of Fetal Care
Keeping Up with Fetal Care Innovation
“Unborn: Management of the Fetus with a Correctable Congenital Defect”-1982
• Representatives from 12 institutions in 5 countries
– To discuss novel approaches
– Possible interventions before birth
• Goal was to change the natural progression of diseases
What are the origins of fetal care?
Harrison, M. et al: Fetal Treatment 1982. N Engl J Med 1982; 307: 1651-1652
• Consensus statement:
1) “Many fetal abnormalities can now be detected.”
2) “Most defects are best treated after birth.”
3) “Only a few disorders are potentially amenable to treatment before birth.”
4) “Fetal deficiencies may be alleviated by the provision of a missing substance.”
What are the origins of fetal care?
Fetal Therapy Networks/Societies
Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint
Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet)
Moon-Grady A.J. Fetal Diagn Ther 2017;42:241-248
Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint
Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet)
Moon-Grady A.J. Fetal Diagn Ther 2017;42:241-248
Fetal Care
Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint
Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet)
Moon-Grady A.J. Fetal Diagn Ther 2017;42:241-248
Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint
Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet)
Moon-Grady A.J. Fetal Diagn Ther 2017;42:241-248
Level-III
Level-IV
Necessary components of a fetal care center
Howell, L. J., & Adzick, N. S. Semin Perinatol 1999; 23:535-540.
• Established in 2013
– Fetal therapy has existed at Yale since 1980’s – One of about 60 U.S. centers
• Member of North American Fetal Therapy Network – 34 North American Centers
• Collaboration between Yale-New Haven Hospital and Yale School of Medicine
Fetal Care Center at Yale
Prenatal Enrollment*
2014 2015 2016*
0 100 200 300 400
Year
N u m b e r o f P a ti e n ts
238 263 298
* Fetal anomalies/conditions requiring at least one Pediatric Subspecialty care.
Fetal Care Visits by Planning Area; FY 2014 - 2016
2014 2015 2016*
0 1000 2000 3000
Year
N u m b e r o f P re n a ta l V is it s
1,562 2,499 2,844
Referral source by town
9
2 1 1
Top Referrals 1. New Haven 2. Bridgeport 3. Milford 4. Stamford 5. Danbury 6. Waterbury
Prenatal Enrollment by Anatomical Category
Cardiac Abdomen Plastics Thorax Neuro Face/Neck Ortho/Skeletal Urologic Genetic Twins/Anemia Other
0 20 40 60 80
Number of Patients
2014 2015 2016*
67 72
61
41 37 38
4 5 6
12 16 17
29
20
14 29
33 43
7 9 5
57 61
75
9 3
12
4 6 7
2 4 5
Completed Prenatal Pediatric Specialty Referrals
CY2014 CY2015 CY2016 Jan - June
153 255
338
0 50 100 150 200 250 300 350 400
Completed Pediatric Specialty
Consultations CY 2014 CY 2015 CY 2016
Card
Surg NICU
Uro
Maternal Anxiety
43,58
29,08
20 40 60
Women with Pregnancies Complicated
by Surgical Fetal Anomaly Women without Fetal or Obstetric Complications
Mat er na l STAI S ta te Scor e
Maternal State Anxiety Scores
10 out of 19 women (58%) ≥40 3 out of 25 women (12%) ≥40
Wilpers AB. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017;46(3):456-64
Socio-Demographic Correlation Findings
Fetal Anomaly Group
r=0.59, p=0.008
84%
5% 11%
Nurse Coordinator Awareness
Aware Not sure Not Aware
n=16
Nurse Coordinator
n=2 n=1
“Were you told that there is a nurse who will coordinate all of your care during your
pregnancy?”
“Does the knowledge of this nursing service make you feel less anxious?”
68%
16%
16%
Nurse Coordinator Awareness and Anxiety
Yes No
Not sure
n=13 n=3
n=3
• Speak to a family with a similar experience: 79%
• Support group: 53%
• Mental health resources: 5%
Psychological Support
Fetal Care Center Support Group
• Established: October 2015
• Funding: grant from Yale-New Haven Hospital Auxiliary (2nd year of funding just awarded)
• Facilitators:
– Lori Burns-Galdenzi, LCSW; MFM Social Worker – Diane Wall, MSN, RN, CNE; Program Coordinator,
Fetal Care Center
• Medical Advisor:
– Katherine Kohari, MD; MFM
Fetal Care Center Support Group
• Meetings:
– monthly (3rd Thursday) from 5:30 - 7:00 p.m. at 1 LW
• Attendees:
– Patients/partners currently pregnant with anomalous fetus.
– Patients who have already delivered continue to attend for their own support needs during the chronic condition
challenges of their baby's health care and to support those currently expecting.
• Light dinner and transportation assistance (bus
passes/taxi vouchers)
• Group effort
• Stake holders should buy-in
• Virtual of physical
• System
– Push – Pull – Hybrid
• Single point of entry
Fetal Care Center
Road Map
Howell, L. J., & Adzick, N. S. Semin Perinatol 1999; 23:535-540.
