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Maternal Fetal Treatments Some conditions, such as Twin-to- Twin Transfusion Syndrome (TTTS) in which one twin "donates" blood to the other through vessels on a shared placenta, can be fatal without pre- natal intervention. Akron Children's perinatologists provide management of monochorionic pregnancies. Other minimally invasive proce- dures offered include fetal transfusions through the umbilical cord for severe anemia, or the placement of a shunt to counteract the kidney-damaging effects of a bladder outlet obstruction. Fetal cardiac arrhythmias can be treated with medications, and fluid around the lungs (pleural effusions) can be drawn off with a needle during ultrasound-guided thoracentesis, giving developing lungs space to grow more normally. Whether treatment is adminis- tered before or after birth, the Fetal Treatment Center can ensure the appropriate specialists are familiar with the case ahead of time so treat- ment can be initiated at the most appropriate time. An example is dia- phragmatic hernia, which can be fatal at birth if specialists are not prepared to perform a ventilating procedure in the delivery room. Preparation for these types of unplanned events starts with the Fetal Treatment Center, where the goal is to improve timeliness in identifying birth defects and com- munication among specialists. "The Fetal Treatment Center aims to put a unified plan in place for patients, so that mom and baby receive seam- less care from everyone on the care team," says Dr. Crane. "If the patient needs a consultation with a pediatric subspecialist such as a cardiologist, neurologist or orthopedist, the Fetal Treatment Center can arrange it, and a nurse coordinator often goes along with the patient to these appointments." "The goal is to help families prepare logistically and psychologically for all Dawn Pekarek, MD, one of three female maternal fetal medicine specialists at Akron Children's, is shown here with genetic counselor Melonie Michelson, MA. Genetic anomalies and familial risk factors often play a critical role in the high-risk pregnancy. types of eventualities," says Dr. Robinson. "That's one of our biggest impacts." Early Referral = Best Outcomes With that in mind, early referral — in some cases even before a woman becomes pregnant — is often the key to achieving the best possible out- comes. Women with medical disorders such as diabetes, heart disease, high blood pressure, kidney disease or a gastrointestinal disease can benefit from a pre-conception maternal fetal medicine consultation. Often, a dis- ability such as a metabolic disorder can be prevented through screening and treatment or management. Pre-conception consultations are also important for women who have prior children with malformations or congenital defects, or who have a family history of genetic disorders. "Some patients have known risk fac- tors, and others don't," says Dr. Crane. "The sooner we can assess a patient's situation and put a cohesive plan in place, involving all appropriate providers, the better the outcome is likely to be." For more information about Akron Children's Maternal Fetal Medicine Center, visit www.akronchildrens.org/mfm. To refer a patient, call 330-543-4500. ■ MARCH-APRIL 2012 n MDNEWS.COM n MD NEWS Cleveland-Akron-Canton | 21 PHOTOS © SMITHBERGER PHOTOGRAPHY, NORTH CANTON