- Fetal echocardiography: Learn about fetal echocardiography.
- Fetal surgery and intervention: If there’s a need for fetal surgery or intervention, the MFCC team will discuss options with you, including risks and long-term outcomes based on our experience and the most current data available.
- Fetal infections: Common fetal infections are cytomegalovirus (CMV), parvovirus, and toxoplasmosis. We offer diagnosis and different treatment options at our center.
- Lower urinary tract obstruction: A posterior urethral valve (PUV) is the most common cause of urinary tract obstruction. It occurs in 1 in 4,000 to 8.000 pregnancies. It’s mostly seen in male fetuses and is caused by disrupted embryologic development of the male urethra at nine to 14 weeks of gestation.
- Lung masses: The main types of fetal lung lesions are congenital cystic adenomatoid malformation (CCAM), bronchial atresia, and sequestration. Their architecture, origin, and blood supply differ and can be diagnosed by ultrasound and fetal MRI. In the MFCC, we offer close follow-up and possible case-by-case interventions for severe cases.
- Monochorionic twins: Twins are generally categorized in two ways: dizygotic (fraternal) makes up 70% of twins. Monozygotic (identical) twins are the second type. Monozygotic twins usually share one placenta (monochorionic) and have two separated amniotic sacs (monochorionic diamniotic). Rarely (about 3% of cases), monozygotic twins share a single amniotic sac (monochorionic monoamniotic). Conditions associated with monochorionic twins include:
- Twin-twin transfusion syndrome: When one twin (donor) is dehydrated and the other (recipient) is overhydrated.
- Selective fetal growth restriction: Usually diagnosed when one twin is below the 10th percentile for gestational age and there is an inter twin growth discordance of above 25%.
- Twin anemia polycythemia sequence: When there is a significant difference in hemoglobin levels between twins.
- Twin reversed arterial perfusion (TRAP): When the cardiac system of one twin supplies blood for both twins. The twin supplying the blood is known as the "pump twin."
Interventions
- Fetal cardiac intervention uses a needle or catheter to treat certain fetal cardiac abnormalities. Tiny balloon catheters can be inflated to open abnormal heart valves or other obstructions.
Other procedures may be performed during or immediately after delivery, including:
- EXIT (Ex Utero Intrapartum Treatment): Performed at 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 (Extracorporeal Membrane Oxygenation): 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.
- Fetal intervention for vein of galen malformations (VOGM): Physicians from Boston Children’s and Brigham and Women’s Hospital are evaluating a new interventional procedure for treating VOGM during pregnancy. The goal of the procedure is to reduce flow through the VOGM before birth. While many patients do well with conventional treatment after birth, some develop severe symptoms within a day or two after delivery and have a higher risk of illness and death, even with expert care. Based on fetal MRI scans, we have developed a method for predicting which fetuses are likely to have this kind of aggressive clinical presentation. This new intervention is aimed specifically at this group.
- Fetal intervention for vein of galen malformations (VOGM): Physicians from Boston Children’s and Brigham and Women’s Hospital are evaluating a new interventional procedure for treating VOGM during pregnancy. The goal of the procedure is to reduce flow through the VOGM before birth. While many patients do well with conventional treatment after birth, some develop severe symptoms within a day or two after delivery and have a higher risk of illness and death, even with expert care. Based on fetal MRI scans, we have developed a method for predicting which fetuses are likely to have this kind of aggressive clinical presentation. This new intervention is aimed specifically at this group.
- Prenatal genetic diagnosis: Our Fetal Precision Genetics Program provides comprehensive genetic testing to help determine congenital anomalies. Testing includes noninvasive prenatal testing (NIPT), carrier screening, chromosomal microarray analysis (CMA), broader gene testing, as well as MRI and ultrasound imaging.
- Prenatal ultrasound: A prenatal ultrasound uses high-frequency sound waves to create an image of your fetus. It’s used to track the growth and development of a fetus.