Comprehensive care for complex, high-risk pregnancies

May 23 2006

As many as 3 percent of all pregnancies result in the birth of a baby with chromosomal anomalies like Down syndrome or structural anomalies such as congenital heart disease.

Expectant mothers whose sonogram or other screening test turns up an abnormality are often referred for specialized prenatal assessment and care. The Center for Prenatal Pediatrics at Morgan Stanley Children's Hospital of NewYork-Presbyterian is the only comprehensive program in the New York metropolitan area, providing a seamless progression of specialized care for complex, high-risk pregnancies from diagnosis to birth and beyond.

"Our comprehensive prenatal program offers expectant mothers one of the nation's largest teams of physicians specialized in detecting and treating the most complex, highest-risk conditions. This gives parents the peace of mind that everything possible will be done to optimize the health of their baby," says Dr. Lynn L. Simpson, medical director of The Center for Prenatal Pediatrics at Morgan Stanley Children's Hospital of NewYork-Presbyterian and director of ultrasound at NewYork-Presbyterian Hospital/Columbia University Medical Center. She is associate professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons.

"We offer mothers the latest screening and diagnostic tests - including some that were developed and validated at our Hospital - to determine the baby's specific condition and initiate appropriate monitoring and treatment, before, during, and after birth," continues Dr. Simpson.

NewYork-Presbyterian/Columbia led the 15-center FASTER trial (First and Second Trimester Evaluation of Risk), which, in 2005, demonstrated the high accuracy of non-invasive maternal serum and ultrasound screening for Down syndrome in the first trimester of pregnancy. This approach is now being implemented nationally as an alternative to traditional second-trimester screening.

Other diagnostic procedures offered at The Center for Prenatal Pediatrics include amniocentesis; chorionic villus sampling (CVS); testing for inborn errors of metabolism and rare genetic diseases; and percutaneous umbilical cord sampling (PUBS). In addition, specialized therapeutic interventions such as the placement of in utero shunts, intrauterine fetal transfusions and radiofrequency ablation can be done at the Center.

The Center's family-oriented and coordinated approach helps prepare parents for the birth of an affected child. A plan of care is developed for the remainder of the pregnancy and for the delivery, including monitoring any necessary or anticipated medical and surgical care for the unborn baby. Management in the immediate newborn period is also coordinated between the maternal fetal medicine specialists, neonatologists, pediatric subspecialists and pediatric surgeons, making the transition to life outside the womb occur as smoothly as possible. Genetic counseling and psychological counseling are available to women and their families as needed.

"We offer established routine and complex pediatric surgical procedures - both in utero and neonatal," says Dr. Charles Stolar, chief of pediatric surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian and the Rudolph N. Schullinger Professor of Surgery and Pediatrics at Columbia University College of Physicians and Surgeons. Dr. Stolar serves on the board of directors of The Center for Prenatal Pediatrics.

Women with high-risk pregnancies treated at the Center deliver their babies in the new Carmen & John Thain labor and delivery unit located on the top floor of the Morgan Stanley Children's Hospital. Many of these babies spend time in the new Morgan Stanley Children's Hospital's state-of-the-art neonatal intensive care unit (NICU). The 62-bed NICU is one of the busiest units in the country, admitting more than 1,000 critically ill infants each year. Designated by New York State as a Regional Perinatal Center, it is well equipped to care for the most difficult, complicated cases. The NICU employs the latest technology, such as electroencephalography (EEG) methods to access brain function, extracorporeal life support (ECMO), and offers innovative programs like its"launching pad," a furnished efficiency apartment in the Hospital where parents can practice taking care of their baby through the night.

In the weeks, months, and years that follow, any necessary medical or surgical care required by children born to families seen at the Center is available. Morgan Stanley Children's Hospital offers the nation's largest pediatric heart transplant program (2004 data), the largest pediatric pulmonary hypertension center in the world, as well as diagnostic and therapeutic interventions, such as radiofrequency ablation for cardiac arrhythmias and balloon valvuloplasty.

With the largest pediatric cardiac services in the tri-state area, the Hospital performs more than 500 pediatric cardiac surgical procedures and 600 cardiac catheterizations every year. This comprehensive care that begins in The Center for Prenatal Pediatrics continues with the expert care available in the Morgan Stanley Children's Hospital. The Hospital is also home to one of the most robust neonatal surgical centers in the United States, with excellent outcomes for all aspects of neonatal surgery, including the latest innovative procedures. Outcomes for neonatal medical challenges, especially respiratory health, are universally acclaimed.

Further information is available at PrenatalPediatrics.org.