Giving babies hope: Center for complex fetal care opens at Yale

Pregnancy and the birth of a child should be one of the happiest times of life. But if your unborn baby has health problems, it can be a time of confusion, worry, and fear. Yale School of Medicine and Yale-New Haven Children’s Hospital are collaborating on a new venture that aims to change things for the better by providing comprehensive services with complete coordination of care in order to help mothers-to-be achieve peace of mind.

As the first center of its kind in the region, the Fetal Care Center is the latest in a long list of firsts in women’s health and perinatal care offered by Yale School of Medicine and Yale-New Haven Hospital. These include the first fetal heart rate monitoring, first intrauterine intravascular fetal transfusion, and the nation’s first neonatal intensive care unit — all designed to advance the mission of delivering state-of-the-art, patient-focused care.

YaleNews spoke with the director of the Fetal Care Center, Dr. Mert Ozan Bahtiyar, associate professor of obstetrics, gynecology and reproductive sciences and nursing.

What is the purpose of the Fetal Care Center?

We have a long history of innovations here at Yale. We have world-class expertise. The Fetal Care Center will allow all patients to easily access this expertise and cutting-edge therapies. At the Fetal Care Center, we will take a multidisciplinary team approach, which will help us to provide more coordinated and efficient care to patients who have fetuses with anomalies and conditions that can be treated with in utero and post-natal interventions. We coordinate and provide all of the necessary care, from diagnosis to delivery, and through the post-natal period. Our goal is for the patient to receive compassionate care more expediently, with fewer trips to the hospital, which helps the patient to feel less anxious, less overwhelmed, and in better control of the situation.

Our multidisciplinary physicians treat a large variety of conditions. We are the only center in Connecticut that treats serious complications associated with identical twin pregnancies. The Fetal Care Center is the first and the only center in Connecticut that performs the fetoscopic laser procedure for advanced twin-twin transfusion syndrome. We are one of the very few centers in the world that treats twin anemia-polycythemia sequence patients with partial exchange transfusion. We perform intrauterine blood transfusion, shunt placements, and radiofrequency ablation. We also treat congenital heart defects, fetal arrhythmias, airway lesions, intracranial abnormalities, fetal anemias, cleft lip or palate, clubbed feet, conjoined twins, spina bifida, intra-abdominal masses, and many more conditions.

A significant number of our patients have fetuses with congenital abnormalities that will require treatment after birth. Our multidisciplinary team of pediatric specialists takes care of these patients from the time of the fetal diagnosis to delivery and through their post-natal period, and the team continues to treat these babies into adolescence and adulthood. The patient receives true continuity of care.

What can patients expect at the Fetal Care Center?

In March 2014 we will open a dedicated Fetal Care Clinic on the second floor of the Yale-New Haven Children’s Hospital, where maternal-fetal-medicine and pediatric specialists will provide prenatal care and counseling to these patients and families, who can tour our newborn intensive care unit so they can see where their baby will be cared for.

Diane Wall, M.S.N., R.N., C.N.E., our fetal care coordinator, is the point of contact for all our patients. Diane meets with our patients at the time of diagnosis and sees them through their pregnancy and beyond, ensuring a seamless transition and an exceptional patient-family focused experience. We also provide other services, such as connecting the patient with social workers, and assisting with housing options when it is necessary for the patient to remain close to the hospital for longer periods of time. Coordinating these services would require a great deal of effort on the patient’s part.

We include our patients in the process of decision-making, but provide them with the support they need to reach their goals. Our conversation with the patient includes, “This is what is happening with your baby; this is our recommendation for treatment; and these are the service we can provide to assist you through this experience. Please let us know what we can do to help you.”

Who do you hope will take advantage of this center?

We already have well-developed relationships with many in-state providers of obstetrical and high-risk maternal care who refer their patients to our center. We hope that by reaching out to our neighboring specialists as well as those beyond our borders, the center will attract patients from the New York, Rhode Island and Massachusetts as well. There are things we can do here that are not widely, or at all, available elsewhere.

What prompted this? What made you want to pull all this together in a coordinated way?

I’m a maternal fetal medicine physician, so I’m at the front end. Coordination of patient care has been difficult at times. The Fetal Care Center will ensure that these patients receive necessary treatment in a timely and thorough manner. We are very confident that this will improve the patient experience and outcomes, from the initial contact, during their pregnancy, and afterward. We are here not only to remind them about their appointments, but to walk with them and go through these difficult times together. We put the patient at the center of the care and tailor everything around them.