Diagnostic imaging and counseling
Our fetal imaging specialists are all board-certified pediatric radiologists and pediatric neuroradiologists with certificates of added qualifications (CAQs) and expertise in the evaluation of both common and rare congenital conditions. Pediatric cardiologists who specialize in fetal imaging perform fetal echocardiography. With sonography (US), magnetic resonance imaging (MRI), echocardiography and radiography, we are able to detect, diagnose and guide treatment for birth defects in utero, at delivery and after birth.
AFCC pediatric radiologists Judy Estroff, MD, Director of Fetal Imaging, and Carol Barnewolt, MD, Director of Ultrasound, and Susan Connolly, MD, perform the ultrasound and/or MR and evaluate and review the results with the rest of the medical team.
Wayne Tworetzky, MD, Co-Director of the AFCC and Director of Fetal Cardiac Imaging, along with a team of skilled fetal cardiologists, perform fetal echocardiograms to diagnose heart defects in utero.
Ultrasound testing uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. The evaluation provides general information about the size and position of fetal organs and how they are functioning.
Although you may have had a routine ultrasound at your obstetrician's office, AFCC pediatric radiologists use state-of-the-art technology and their unique experience to produce and analyze detailed images of your unborn child. The procedure is conducted in an exam room by a radiology technologist and an AFCC pediatric radiologist. You will be asked to lie still while the clinician moves a receiver called a transducer over your abdomen. Your AFCC pediatric radiologist records detailed images of the entire pelvis.
Family members and partners are welcome to accompany the mother to the procedure room. The procedure is painless, takes about one hour and is safe for you and your baby. You are allowed to eat and drink prior to testing, however, we recommend avoiding caffeine because it can make the baby more active during assessment. Also, a "full bladder" is not required.
MR is a diagnostic test that uses a combination of a large magnet, radio frequencies and a computer to produce detailed images of organs and structures within the body. The MR machine is a large, tube-shaped machine that creates a strong magnetic field around the patient.
This magnetic field, along with a radio frequency, alters the alignment of hydrogen atoms in the body. Computers are then used to form two-dimensional images of fetal organs based on the response of the hydrogen atoms. No radiation is used and, based on years of experience, there are no known harmful effects.
Family members and partners are welcome to accompany the mother to the procedure room. The MR procedure takes 30 minutes to an hour. You are allowed to eat and drink prior to testing although, as with ultrasound, we recommend avoiding caffeine because it can make the baby more active during assessment. Also, a "full bladder" is not required and this test is safe for you your baby.
Fetal echocardiogram (fetal echo), a highly specialized, detailed ultrasound examination of the fetal heart, performed in the event a fetal cardiac abnormality is suspected or when hemo-dynamic assessment is warranted.
What happens next?
Once your studies are completed, the AFCC radiologists review the images with nursing staff and pediatric specialists. Following this review, you will meet with the team to go over the results, discuss what the findings mean for the fetus for the remainder of the pregnancy, and review expected outcomes after birth related to surgery, hospitalization, and long-term health. You will have time to review the images and ask questions.
Our goal is to provide the most complete information about a diagnosis and treatment. We honor and support the personal treatment decisions that each family ultimately makes.
We remain available for consultation throughout the pregnancy, and our nursing staff continues as the liaison to you and your physician to answer any questions. We can also assist you in setting up consultations with local high-risk obstetricians if you choose to deliver your baby close to Boston Children's Hospital. For high-risk cases, we assist in the coordination of complex deliveries to assure pediatric specialists' presence and evaluation after birth.
Surgery and interventions
Surgery or other intervention becomes an option when doctors predict that the fetus will not live long enough to make it to delivery or live long after birth. New treatments and supportive care through the AFCC are improving the quality of life for this special group of newborns through their first years and throughout childhood.
If there is a need for a fetal intervention, the AFCC team will discuss options with you, including risks and long-term outcomes based on our experience and the most current data. All necessary services are centrally coordinated by the AFCC team.
Interventions performed by the AFCC include:
- Fetoscopic surgery, which uses minimally invasive techniques to correct congenital malformations without the need to remove the fetus from the womb.
- Fetal cardiac interventional procedures, using a needle or catheter to treat certain fetal cardiac abnormalities. Tiny balloon catheters can be inflated to open abnormal heart valves or other obstructions. Boston Children's Hospital is the only hospital to date successfully performing these procedures.
- EXIT (Ex utero intrapartum treatment) conducted at the time of the delivery, often for a congenital defect that blocks the airway. The baby is partially delivered through Cesarean section and remains on placental support (still attached to the umbilical cord), giving surgeons time to treat the obstruction and secure the baby's airway so that by the time the cord is cut, the baby can breathe independently.
- EXIT to ECMO (extra corporeal membranous oxygenation), where, following an EXIT procedure, a baby is temporarily placed on a heart/lung bypass machine that circulates oxygenated blood through the body. Surgeons are then able to complete the delivery and repair the abnormality while giving the baby's lungs and heart time to develop and heal.
- Additional surgery, performed as needed once the newborn is stabilized.