Care Levels for Fetal Therapy Centers
- PMID: 35675600
- PMCID: PMC9202072
- DOI: 10.1097/AOG.0000000000004793
Care Levels for Fetal Therapy Centers
Abstract
Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties. Three care levels for fetal therapy centers are proposed to match the anticipated care complexity, with appropriate resources to achieve an optimal outcome at an institutional and regional level. A level I fetal therapy center should be capable of offering fetal interventions that may be associated with obstetric risks of preterm birth or membrane rupture but that would be very unlikely to require maternal medical subspecialty or intensive care, with neonatal risks not exceeding those of moderate prematurity. A level II center should have the incremental capacity to provide maternal intensive care and to manage extreme neonatal prematurity. A level III therapy center should offer the full range of fetal interventions (including open fetal surgery) and be able manage any of the associated maternal complications and comorbidities, as well as have access to neonatal and pediatric surgical intervention including indicated surgery for neonates with congenital anomalies.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Conflict of interest statement
Financial Disclosure Ahmet A. Baschat disclosed receiving royalties from UpToDate. James J. Cummings disclosed that he receives funding from ONY Biotech, Amherst, NY—first as a consultant, then later as a part-time employee. During the time this report was being prepared, he served as chair of a national committee (American Academy of Pediatrics, Fetus and Newborn). This was a voluntary, uncompensated position. Sarah J. Kilpatrick disclosed receiving funding from Contemporary OB/GYN, and Kaneka Corporation, and the textbook, Obstetrics—Normal and Problem Pregnancies. She also disclosed receiving royalties from UpToDate. Anita J. Moon-Grady is an unpaid board member for the Fetal Heart Society and a board member of the AIUM. She reported that this article discusses off-label use of approved intravascular devices, such as balloon catheters. The other authors did not report any potential conflicts of interest.
Comment in
-
Care Levels for Fetal Therapy Centers.Obstet Gynecol. 2022 Sep 1;140(3):523-524. doi: 10.1097/AOG.0000000000004913. Obstet Gynecol. 2022. PMID: 36356245 No abstract available.
Similar articles
-
Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.Cochrane Database Syst Rev. 2015 Nov 27;2015(11):CD008925. doi: 10.1002/14651858.CD008925.pub2. Cochrane Database Syst Rev. 2015. PMID: 26611822 Free PMC article. Review.
-
Individualized treatment of preterm premature rupture of membranes to prolong the latency period, reduce the rate of preterm birth, and improve neonatal outcomes.Am J Obstet Gynecol. 2022 Aug;227(2):296.e1-296.e18. doi: 10.1016/j.ajog.2022.02.037. Epub 2022 Mar 5. Am J Obstet Gynecol. 2022. PMID: 35257664
-
The relationship of the subtypes of preterm birth with retinopathy of prematurity.Am J Obstet Gynecol. 2017 Sep;217(3):354.e1-354.e8. doi: 10.1016/j.ajog.2017.05.029. Epub 2017 May 22. Am J Obstet Gynecol. 2017. PMID: 28545834
-
Maternal and obstetric complications in fetal surgery for prenatal myelomeningocele repair: a systematic review.Neurosurg Focus. 2019 Oct 1;47(4):E11. doi: 10.3171/2019.7.FOCUS19470. Neurosurg Focus. 2019. PMID: 31574465
-
Fetoscopic spina bifida repair.Minerva Ginecol. 2019 Apr;71(2):163-170. doi: 10.23736/S0026-4784.18.04355-1. Epub 2018 Nov 27. Minerva Ginecol. 2019. PMID: 30486637 Review.
Cited by
-
Precarious hope: Ethical considerations for offering experimental fetal therapies outside of research after initial studies in humans.Prenat Diagn. 2024 Feb;44(2):180-186. doi: 10.1002/pd.6474. Epub 2023 Dec 9. Prenat Diagn. 2024. PMID: 38069681
References
-
- Harrison MR, Filly RA, Golbus MS, Berkowitz RL, Callen PW, Canty TG, Catz C, Clewell WH, Depp R, Edwards MS, Fletcher JC, Frigoletto FD, Garrett WJ, Johnson ML, Jonsen A, De Lorimier AA, Liley WA, Mahoney MJ, Manning FD, Meier PR, Michejda M, Nakayama DK, Nelson L, Newkirk JB, Pringle K, Rodeck C, Rosen MA, Schulman JD. Fetal Treatment 1982, N Engl J Med 1982; 307: 1651–2; DOI 10.1056/NEJM198212233072623 - DOI - PubMed
-
- Moon-Grady AJ, Baschat A, Cass D, Choolani M, Copel JA, Crombleholme TM, Deprest J, Emery SP, Evans MI, Luks FI, Norton ME, Ryan G, Tsao K, Welch R, Harrison M. Fetal Treatment 2016: the Evolution of Fetal Therapy Centers. A joint statement from the International Fetal Medicine and Surgical Society and the North American Fetal Therapy Network. Fetal Diagn Ther. 2017; 42: 241–248; DOI 10.1159/000475929 - DOI - PMC - PubMed
-
- https://naftnet.org/WhatisFetalTherapy/tabid/66/Default.aspx, accessed 2/7/2022
-
- Shue EH, Hirose S. History and overview of Maternal-Fetal Surgery. In: Fetal Diagnosis – A reference handbook for Pediatric Surgeons. Eds: Feltis B, Muratore C, American Pediatric Surgical Association, 2013.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources