Ask the Expert: Ahmet Baschat Talks About the New Center for Fetal Therapy

The Johns Hopkins Center for Fetal Therapy, which specializes in diagnosing and correcting rare and complex diseases in the womb, opened its doors in July. With specialists in fetal, maternal, neonatal and pediatric care, the team is changing lives by identifying and treating a growing number of conditions before birth. The Center for Fetal Therapy takes a comprehensive approach to achieve this goal in caring for patients by integrating the full spectrum of clinical and support services.

ahmetbaschat2The director of the center, Ahmet Baschat, is a veteran in maternal-fetal medicine. He was one of the first published authors in the field regarding the potential benefits of a newly modified laser technique for twin-to-twin transfusion syndrome, which has been widely adapted as the standard of care. Baschat will be one of 32 presenters at the 20th annual A Woman's Journey conference on Sat., November 1, where he will speak about how diseases can be treated in utero to preserve life. Visit hopkinsmedicine.org/awomansjourney for more information and to register for this event.

What is fetal therapy?

Fetal therapy is the management of conditions that affect the unborn child. Fetal therapy ranges from direct surgical interventions on the baby, minimally invasive treatments such as fetoscopy, to medical treatments that are either given to the baby directly or to the mother as administered medication that cross the placenta. Part of the treatment is the surveillance for known complications and making absolutely sure that the baby is delivered in the best condition to a pediatric team that is aware of the full spectrum of problems they have to deal with. So it really is a multidisciplinary approach that initiates the treatment for a range of conditions before the baby is born.

What does the Center for Fetal Therapy do? What distinguishes it from other centers in the fetal medicine field?

The Center for Fetal Therapy offers prenatal diagnosis, prenatal assessment of specific conditions, and the counseling and support of all family-related issues that are part of preparing the family to deal with a complicated fetal problem. We offer fetal treatments, both invasive and noninvasive, such as operative fetoscopy and medications. We offer specific delivery timing in coordination with our pediatric colleagues. In addition, we provide maternal management, which is sometimes required, as fetal conditions can also affect the mother.

The important difference between the Center for Fetal Therapy at Johns Hopkins and many fetal therapy centers that exist is that here, all fetal, medicine, maternal medicine, obstetric, pediatric and long-term services are all available under one roof. That is a very unique combination that isn’t offered in many fetal therapy centers.

Why was it important to create this center at Johns Hopkins?

Prior to the opening of the Center for Fetal Therapy at Johns Hopkins, fetal treatments were offered through the Prenatal Diagnosis and Treatment Center. What is different about the Center for Fetal Therapy is it offers more prenatal treatments. We have created a dedicated service that is expanding to offer all the invasive and noninvasive treatment options that are available in the field of fetal therapy.

We also are building a research infrastructure that is absolutely essential to improve these treatments.

In addition, we are instituting a fetal intervention training program, where future physicians, who will be leading this specialty forward, can be trained in the disease-specific applications of all the other techniques that obstetricians and maternal-fetal medicine physicians may use.

How does the decision-making process work as far as how the fetus is treated?

We are trying to establish the most accurate assessment of the condition. Based on the diagnosis, we counsel patients about what the likely outcomes will be. That includes the counseling of outcomes with and without treatments. Then, we present the possible treatment options—there is always more than one option. Next, the risk-benefit ratio is discussed—this is a very individual decision that parents make. At the end of the counseling process, it is imperative for patients to understand what it is that we are dealing with, what will happen if we don’t do something, what we can achieve by doing something, and what the risks to the mother and the fetus are. Based on that, parents have to make a decision.

In conditions that are more complicated, we will sometimes include counseling from colleagues in pediatric surgery, neonatology or pediatrics. This specifically applies to conditions such as spina bifida or congenital diaphragmatic hernia, where it is expected that specific care after delivery will still be required. The prenatal treatment alleviates the amount of damage that is caused by the conditions before delivery.

Why is the management of maternal health so imperative to fetal therapy?

The ability to manage maternal health is imperative, because fetal conditions can affect maternal health, maternal health can affect the fetal conditions and sometimes the treatments we administer have side effects that are pregnancy-specific. So it really is not possible to offer comprehensive care for fetal conditions without also being able to manage complications that can arise in the mother, including preterm labor and cervical shortening. Sometimes even cardiovascular conditions arise when babies are very, very sick, and the recognition of these problems and their management fall into the area of maternal-fetal medicine.

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