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Fetal Care
 

Dr. Ed Yang Performing Fetal SurgeryConditions We Treat

The St. Louis Fetal Care Institute is the only comprehensive fetal care center in middle America. We are one of the few programs in the U.S. that can diagnose life-threatening fetal abnormalities and treat them with open and minimally invasive fetal surgery.

Led by physicians who are experienced in leading-edge treatments and technologies, our expert team will ensure the best possible results for you and your baby. Our nationally recognized doctors offer exceptional care for expectant mothers and their developing babies.

If you don't see the condition you are looking for, or are looking for more information on one of the conditions listed below, contact us. We're available 24 hours a day to answer your questions. Call us at 314-268-4037 or toll-free at 877-SSM-FETL, or e-mail us at fetalcare@ssmhc.com.

 

Amniotic Band Syndrome (ABS)

ABS Patient Charlie With Mom and Dr YangAmniotic Band Syndrome, or ABS, is a condition in which strands of the amniotic sac’s inner lining (amnion) attach to the fetus. These amniotic strands can wrap themselves around body parts and constrict blood flow, making amputation of limbs and birth defects a concern. There is also a strong link between ABS and the birth defect known as clubfoot.

Treatment of ABS is typically performed immediately after the baby is born. In rare cases, fetal intervention may be performed to remove amniotic bands that may amputate a limb or threaten the umbilical cord. One fetal treatment for amniotic band syndrome is fetoscopic laser photocoagulation, in which the amniotic bands constricting the fetus are removed using a fetoscopic laser. Extensive consultations and advanced diagnostics are needed before using fetal surgery to correct ABS, as every case is different and presents a unique set of challenges.

• Charlie was diagnosed and treated for ABS at the St. Louis Fetal Care Institute while still in the womb. Click here to read his story.

 

Congenital Diaphragmatic Hernia (CDH)

CDH, congenital diaphragmatic hernia, occurs when an abnormal opening in the chest cavity allows internal organs such as the stomach, small intestine, spleen, liver and kidney to develop in the chest cavity instead of the abdomen. The displaced organs prevent the lungs from developing properly and most babies are both with respiratory distress. The severity of the disease can vary widely from immediate, severe distress to no clear effect at all.

Treatment of the fetal diaphragmatic hernia includes extensive evaluation to determine the future severity of the disease. Usually a focused ultrasound, fetal MRI and fetal echocardiogram are required to assess the severity of the diaphragmatic hernia. We have performed extensive research in diaphragmatic hernia in newborns and the outcome of the babies. The Lung to Head Ratio (LHR), liver position, total lung volume and echocardiogram are the primary means by which we evaluate the risk.

Dr. Yang and Dr. Vlastos have worked with numerous congenital diaphragmatic hernia patients at the St. Louis Fetal Care Institute at SSM Cardinal Glennon Children's Medical Center.

• Click here to read an article about a CDH tracheal occlusion procedure.

 • Read about a CDH baby who was the first baby born at SSM Cardinal Glennon Children's Medical Center.

• A touching look at having an unborn baby diagnosed with CDH from a father's perspective.

• Watch a Fox2 News story about a CDH surgery at the St. Louis Fetal Care Institute.

• CHERUBS (The Association of Congenital Diaphragmatic Hernia Research, Awareness and Support) helps families and medical care providers of children born with CDH.

Congenital Cystic Adenomatoid Malformation (CCAM)
A CCAM is a cystic mass which forms in the lung tissue of a fetus. The mass is usually located in one lung, and it does not function as normal lung tissue. The cause of a CCAM is unknown, and it is not related to anything the mother did or did not do during the pregnancy.

No cases of recurrence in a sibling have been reported. CCAMs are detected during a routine prenatal ultrasound. The cyst appears as a bright mass in the area of the chest where only lung tissue should be seen. The size and location of the cystic mass may cause the heart to shift to the opposite side of the chest or push downward on the baby’s diaphragm.

The diagnosis can be confirmed with a fetal magnetic resonance imaging (MRI) exam which will also document the size and location of the CCAM. Another test that may be recommended is a fetal echocardiogram. This is an ultrasound of the heart performed by a pediatric cardiologist. This test is recommended to rule out structural heart defects and assess heart function.

Click here to learn more about Congenital Adenomatoid Malformation.

 

Giant Neck Masses (GNM)

Giant neck masses are tumors that can grow large enough to distort and obstruct the baby’s airway. For a baby with a significantly obstructed airway, open fetal surgery known as an EXIT procedure may be needed to clear the airway before the baby is born.

 

Hypoplastic Left Heart Syndrome (HLHS)

HLHS is a congenital heart defect in which the left side of the heart does not develop properly. The left ventricle, which pumps to the body, and the aorta, responsible for carrying the blood, is too small. In hypoplastic left heart syndrome, the valves that regulate blood flow into the left ventricle and to the aorta are too narrow or closed.

 

Twin to Twin Transfusion Syndrome (TTTS)

Twin-twin transfusion patients Aidan and Adrian When the developing fetuses of twins in the womb share a placenta that contains abnormal blood vessels TTTS syndrome, or twin twin transfusion syndrome occurs. These blood vessels connect the umbilical cords and circulatory systems of the twins. One twin receives more blood than the other – a condition that is harmful to both the baby who doesn’t receive enough blood and the baby who receives too much.

Treatment of TTTS pregnancy depends largely on how far the syndrome has progressed. One treatment that has been used successfully is fetoscopic laser photocoagulation, in which a thin fiber is inserted through an incision in the mother’s stomach. Blood vessels that are connected between the twin fetuses are closed using the laser technology, and extra amniotic fluid is removed from around the larger twin to regulate.

• Meet Aidan and Adrian who were diagnosed with twin twin transfusion syndrome in the womb.

 

Twin-Reversed Arterial Perfusion Sequence (TRAP Sequence)

Treating a congenital diaphragmatic hernia using a hydrogel blockTwin reversed arterial perfusion sequence (TRAP) is a rare birth condition in which a fetus born without a functioning heart takes the blood supply from its fully formed twin, known as a “pump” twin. The heart of the pump twin has to work harder to compensate for the blood that is being taken by the nonviable, acardiac twin. This overexertion of the developing heart puts the pump twin at risk for heart failure.

Treatment of TRAP includes radiofrequency ablation, a procedure in which a very thin needle is inserted into a major blood vessel of the acardiac twin. Special radiofrequency currents are passed into the acardiac fetus’ body, where they burn the area around the major blood vessel to stop the flow.

Without the acardiac twin collecting all the blood, this allows the normal fetus to commence the blood circulation it needs to grow and thrive. Another method that may be used is bipolar cord coagulation, in which a needle and fetoscope is placed into the amniotic area of the uterus. The fetoscope is used to determine what space would be best for cauterization, a process which stops blood flow to the abnormal fetus. This procedure often needs to be performed more than once to work effectively.

 

Sacrococcygeal Teratoma (SCT)

The most common type of tumors found in newborns, typically located between the coccyx and the sacrum, a bone at the end of the vertebral column, are known as Sacrococcygeal Teratomas, or SCT. These tumors can actually become as large as the baby himself. When a tumor becomes enlarged, it puts tremendous strain on the heart as it works to circulate blood through the baby’s developing body and the tumor.

Treatment of SCT includes a resection – an open surgery in which the surgeon opens the uterus to expose and remove the baby's tumor from the fetal circulation path. The surgeon removes the tumor and seals the wound in the baby’s lower back. The surgeon then seals the uterus and returns the baby to the womb. This treatment requires several days of rest for the mother.

Additional Fetal Conditions We Treat Include:

Lung Problems
Congenital Diaphragmatic Hernia (CDH)
Congenital Cystic Adenomatoid Malformation (CCAM)
Pulmonary Sequestration
Fetal Chylothorax or Hydrothorax
Pulmonary Agenesis

Twin Abnormalties
Twin-Twin Transfusion Syndrome (TTTS)
Twin-Reversed Arterial Perfusion Sequence (TRAP Sequence)
Discordant Intrauterine Growth Restriction (IUGR)
Discordant Structural Anomalies

Congenital Heart Diseases
Congenital Heart Block
Hypoplastic Left Heart Syndrome (HLHS)
Pulmonary Atresia with Intact Ventricular Septum

Abdominal Wall Defects
Gastroschisis
Omphalocele

  • CNS Lesions
    • Anencephaly
    • Hydrancephaly
    • Hydrophalus
    • Myelomeninocele (Spina Bifida)
    • Holoprosencephaly
    • Encephalocele
    • Vein of Galen Aneurysm
  • Urologic Problems
    • Bladder Outlet Obstruction (BOO)
    • Hydronephrosis
    • Dysplastic kidneys
  • Congenital Heart Disease

Intestinal Problems
Duodenal and Intestinal Atresia
Esophageal Atresia with Tracheoesophageal Fistula
Meconium Ileus
Imperforate Anus

  • Limb Problems
    • Skeletal Dysplasia
    • Amniotic Band Syndrome
    • Airway Problems
      Cystic Hydgroma
      Micrognathia
      Congenital Airway Obstruction (CHAOS)
      Giant Neck Masses

Don't see the condition you are looking for, or looking for more information on one of the conditions listed? Let us know,we’re available 24-hours a day to answer your questions. Call us at 314.268.4037 or toll free at 877-SSM-FETL, or e-mail us at fetalcare@ssmhc.com.