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Hospitals join forces to help deal with fetal abnormalities
By Tim Puet
Catholic Times
Mount Carmel Health has joined forces with three other Columbus-area hospital systems in a cooperative venture designed to give infants with suspected fetal abnormalities the high-quality care and supportive environment that is crucial to their development.
Mount Carmel, Nationwide Children’s Hospital, The Ohio State University Medical Center, and OhioHealth/Riverside Methodist Hospital are equal partners in the Columbus Fetal Medicine Collaborative, which was formed earlier this month after about two years of discussion among specialists in fetal care at the four institutions.
“It’s been exciting to be able to put the collaborative together and strengthen the relationship between the four groups,” said Dr. Phillip Shubert, director of perinatology for Mount Carmel Health. “We’ve always had a good relationship to begin with, and the collaborative will allow all of us to get together in one arena to maximize care for unborn children who need the best we can give them.
“In the end, we want to optimize the outcome for mother and child in complicated pregnancies.”
Perinatologists are physicians who specialize in high-risk pregnancies. The collaborative is structured to work with them to identify all issues involved in such pregnancies, determine the best possible treatments, and provide continuous support from fetal diagnosis through newborn care.
Specialties available through the collaborative include cardiology, pediatric surgery, neonatology, neurosurgery, interventional radiology, imaging, anesthesia, craniofacial surgery, neurology, cardiothoracic surgery, orthopedics, clinical genetics, urology, otolaryngology, and hospice and palliative care.
Collaborative members meet each month for case conferences to assure a seamless, integrated approach to services provided by a fetal medicine coordinator who schedules tests, arranges appointments with specialists, and can assist in selecting a perinatologist. The coordinator answers questions and serves as a single source of information from the moment a child is referred to the collaborative.
All four hospital systems in the collaborative work with hospitals in outlying areas of central and southern Ohio which cover most of the Diocese of Columbus. Hospitals in each of the systems, including Mount Carmel-St. Ann’s Hospital in Westerville, where Dr. Shubert is stationed, have telemedicine suites consisting of large flat-screen panel monitors, high-definition cameras, and supporting transmission technology.
Telemedicine technology allows the sharing of video such as ultrasound images and spoken input, as well as static information such as X-ray images, lab results, and MRI pictures. All this is important to help those involved in treating a fetal abnormality reach a consensus on diagnosis, treatment, and windows for intervention.
“Let’s take a hypothetical case of a young woman who lives three hours away from Columbus, visits her local obstetrician, has an ultrasound taken, and learns there’s the possibility of a fetal malformation which would need the assistance of a specialist in perinatal medicine,” said Dr. Donna Caniano, co-chair of the cooperative. She is surgeon-in-chief and chief of pediatric surgery at Nationwide Children’s Hospital.
“This patient would be referred to a specialist at one of the four members of the collaborative. That specialist would perform a Level 2 ultrasound, which would go into greater detail than the original ultrasound.
“Let’s say that specialist is at St. Ann’s, finds something such as a malformation in the abdomen, and needs to immediately consult me. Thanks to the telemedicine suites at each of our hospitals, both of us can look at the ultrasound and at each other, decide how we want to handle the situation, and form a team to start treatment. We might also find some other concerns and determine we want to do an ultrasound of, for instance, the baby’s heart.
“Through ultrasounds, we’re able to discover most fetal abnormalities between the 16th and 20th week of a pregnancy,” Dr. Caniano said. “This gives us enough time to be able to determine a course of treatment that will lead to the best outcome for mother and child.
“It also helps the parents. It’s wonderful to be able to give them the social support they need, with the help of people such as social workers, nurses, and chaplains, all of whom would be called to help with cases like this imaginary one.
“We know that parents who receive a diagnosis of fetal problems go through the same stages of grief that survivors go through because of the death of a loved one. These include shock, disbelief, denial, confusion, anger, and eventual acceptance. An early diagnosis helps give those parents and other family members the social support they need.”
Each of the four hospital groups in the collaborative has a fetal medicine unit which will bring its own areas of expertise to the combined effort. Mount Carmel-St. Ann’s has a maternal fetal diagnostic center which provides comprehensive, state-of-the-art diagnostic and monitoring services and genetic counseling.
The center has been recognized by the National Institute of Child Health and Human Development and approved as a satellite research site for the OSU Medical Center’s maternal fetal medicine division.
Dr. Shubert said more than 8,800 babies were born in the last fiscal year at the three Mount Carmel hospitals with maternity units – about 4,800 at St. Ann’s, 1,600 at Mount Carmel West near downtown Columbus, and 2,400 at Mount Carmel East, near St. Therese’s Retreat Center in eastern Franklin County.
“We probably have about 10 to 15 cases at any given time involving the type of fetal abnormalities which would be addressed by the collaborative,” he said. “I’ve presented three to the collaborative since its inception.”
As indicated by its name, Nationwide Children’s Hospital specializes in treating the medical conditions of infants and young people. It is one of the largest neonatal care centers in the nation and has some facilities for the treatment of newborns which the other area hospitals do not. That means some infants born at other hospitals are sent there after birth or are born there because the hospital is best able to care for them.
“Historically, each of the four members of the collaborative pretty much managed fetal abnormalities independently, then they’d orchestrate a delivery at Children’s if it was felt that was the best decision,” Dr. Shubert said.
“The collaborative gives us the chance to work on more of a team approach, which allows these cases to continue to be managed by the patient’s own physician, with resources such as telemedicine and the mobilization of the entire collaborative all responding to individual needs.
“Depending on the situation, it might enable some infants to stay in the hospital where they were born rather than being moved. Bringing together all these specialized facilities on one palette can do nothing but improve the outcome for a parent and child.”
Dr. Shubert said one of the advancements currently being researched at Children’s involves the possibility of operating on infants while they are still attached to the placenta or the umbilical cord.
Dr. Caniano said San Francisco, Philadelphia, and Cincinnati have some of the nation’s top fetal medicine programs, but they are independent rather than collaborative. She said the Columbus program’s collaborative nature makes it unique among those with which she is familiar. Dr. Shubert said that Mount Carmel Health’s president and chief executive
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