Overview
The Carmen and John Thain Center for Prenatal Pediatrics, located at NewYork-Presbyterian Morgan Stanley Children’s Hospital, provides comprehensive and advanced care to pregnant women and their fetuses after a significant birth defect or genetic condition has been detected, and for women with complicated multiple gestations and pregnancies that might benefit from in utero fetal therapy. Our multidisciplinary team of specialists in high-risk obstetrics and pediatrics collaborate to determine the best plan of care for you and your fetus, both during and after your pregnancy. We provide seamless access to care into childhood, with neonatal and long-term pediatric follow-up, to give your child the best start in life.
The Carmen and John Thain Center for Prenatal Pediatrics has the only program in New York City offering fetal intervention to repair myelomeningocele, a form of spina bifida associated with substantial neurological disability after birth. Performing this surgery while the fetus is still in the womb has been shown to significantly improve results by reducing the need for ventriculoperitoneal shunt (VPS) placement and enhancing neuromotor outcomes.
About Our Program
At the Carmen and John Thain Center for Prenatal Pediatrics, we are committed to giving women and their fetuses the most sensitive, complete, and up-to-date care. Our goal is to provide the best picture of what you might expect during pregnancy, at delivery, and after birth. Early diagnosis, thorough evaluation and ongoing monitoring, gives us the best information to coordinate your delivery and maximize the best possible outcomes.
We care for women with high risk pregnancies complicated by fetal anomalies, fetal genetic conditions, complicated multiple gestations, and pregnancies that might benefit from in utero fetal therapy. Our specialists are leading experts in maternal-fetal medicine, neonatology, genetics, and pediatric subspecialties who collaborate to provide a full range of prenatal diagnostic testing, genetic counseling, fetal therapy and surgery, and pregnancy management, with planning for future pediatric care.
When you receive care at the Center for Prenatal Pediatrics, you receive most of your care in one convenient location. Whenever possible, we create an appointment plan so that you can meet with the multiple subspecialists involved in your case. Some patients come here for a second opinion and return to their obstetrician. Other patients transfer their care to the Center as their delivery date approaches for specialized pediatric care after the child is born.
Areas of Expertise
Expertise in Twin-Twin Transfusion Syndrome (TTTS)
We have special expertise in treating twin-twin transfusion syndrome (TTTS) — a condition in which a single placenta is shared unequally by a set of identical twins. If left untreated, TTTS can lead to premature birth, complications or illness for one or both fetuses, and loss of pregnancy. We use fetoscopic selective laser photocoagulation (SLP) to treat TTTS between weeks 16 and 26 of the pregnancy to enhance the chance of a healthy birth for both fetuses. Our hospital is one of only a handful of centers nationally, and the only center in New York City, to offer this innovative approach to TTTS syndrome.
Fetoscopic Surgery to Repair Myelomeningocele
We have the only program in New York City offering prenatal intervention to repair myelomeningocele, a form of spina bifida associated with a significant neurologic disability after birth. Performing this surgery while the fetus is still in the womb has been shown to significantly improve results by reducing the need for ventriculoperitoneal shunt (VPS) placement and enhancing neuromotor outcomes.
Expertise in the EXIT Procedure
We work with a team of high-risk pregnancy experts to perform the EXIT (Ex-Utero Intrapartum Therapy) procedure when the fetus has a condition, such as a neck or facial mass, that could compromise the newborn’s airway at birth. During a C-section, the team inserts an airway tube while the child is still connected to the mother through the umbilical cord. The EXIT procedure secures the airway while the team addresses the condition before delivery.
Expertise in Fetal MRI
We have special expertise in fetal MRI, which can be a useful adjunct to ultrasound imaging for certain fetal conditions.
ECMO
We are the only hospital in New York City offering extracorporeal membrane oxygenation (ECMO), which may be required to help newborns with congenital diaphragmatic hernia, lung lesions, or certain types of congenital heart disease.
Services We Offer
At the Center for Prenatal Pediatrics, we utilize state-of-the-art ultrasound imaging.
Prenatal Imaging
- 2D ultrasound: Prenatal ultrasound uses high frequency sound waves to create an image of the uterus, placenta, and fetus. An ultrasound can be performed throughout the entire pregnancy, however it is commonly performed at certain times, such as in the first trimester (between 11 and 14 weeks) to obtain the nuchal translucency and accurate dating and in the second trimester (between 18 and 22 weeks) to survey the fetal anatomy.
- 3D and 4D ultrasound: Using similar technique and technology as with the 2D ultrasound, a 3D ultrasound can produce detailed images of the fetus similar to a photograph. This is particularly useful if certain/specific abnormalities are suspected. 4D ultrasound enables real-time 3D imaging of the fetus.
- Fetal echocardiography: Fetal echocardiography is a specialized ultrasound to evaluate the fetal heart. The images are interpreted by a specialist in congenital heart disease.
- MRI: A fetal MRI (magnetic resonance imaging) manipulates magnetic fields to obtain views of the fetus, the placenta, and the maternal uterus and body from many different angles. It can be especially useful for obtaining images of the fetal brain, chest, and abdomen, as well as for diagnosing placental abnormalities.
Diagnosis and Screening
- Chorionic villus sampling (CVS): CVS is a prenatal test typically performed between 10 and 14 weeks of pregnancy. It is the withdrawal of a small amount of chorionic tissue (part of the placenta), by either a catheter through the cervix or a needle inserted into the abdomen.
- Amniocentesis: Amniocentesis is typically performed at 15 weeks or greater in pregnancy. In this procedure, a small amount of amniotic fluid (fluid surrounding the unborn fetus) is withdrawn from the uterus by a thin needle through the abdomen. Like the CVS, the procedure is done under ultrasound guidance and can detect chromosome abnormalities, such as aneuploidy, large duplications or deletions, and large rearrangements, with 99.6 to 99.8 percent accuracy. The procedure can also detect open neural tube defects (spina bifida and anencephaly) and abdominal wall defects with approximately 95 percent accuracy.
Fetal Cardiology
Located at our renowned children’s hospital, NewYork-Presbyterian Morgan Stanley Children’s Hospital, the Fetal Cardiac Program is one of the largest of its kind in the United States. Pediatric cardiologists with expertise in fetal cardiology work closely with maternal-fetal medicine, genetics, pediatric cardiothoracic surgery, and other sub-specialists in the Carmen and John Thain Center for Prenatal Pediatrics to provide the most comprehensive and compassionate care for children diagnosed with congenital heart disease before birth. Our center provides care for both mother and fetus from the time of prenatal diagnosis through birth and beyond.
Some of the fetal heart conditions we treat include:
- Arrhythmia
- Atrioventricular Septal Defect
- Ebstein's Anomaly
- Hypoplastic Left Heart Syndrome (HLHS)
- Tetralogy of Fallot
- Transposition of the Great Arteries
- Truncus Arteriosus
- Ventricular Septal Defect
Fetal Cardiac Therapy
There are many different types of congenital heart defects, and most of the time treatment is initiated at birth or shortly afterward. However, advances in our understanding of congenital heart disease before birth, as well as improvements in technology, have made it possible to treat some patients before they are born. For example, arrhythmias may be treated by giving the mother medication that crosses the placenta to help the fetus prior to birth.
We have recently initiated a program to offer fetal cardiac intervention for a select group of heart conditions in an effort to alter their severe natural histories. We offer procedures for fetuses with severe aortic stenosis and evolving hypoplastic left heart syndrome as well as for fetuses with established hypoplastic left heart syndrome and a highly restrictive or intact atrial septum. We will also consider in utero therapy for fetuses affected by pulmonary atresia with intact ventricular septum. Our goal is to make sure that every fetus has the best treatment options available today for his or her condition.
Fetal Therapy
For some severe diagnoses in pregnancy, prenatal therapeutic treatments – known as fetal therapy – can be performed, with the objective of improving birth outcomes. These treatments include medical and surgical procedures, such as fetoscopic selective laser photocoagulation, cordocentesis, and radiofrequency ablation.
Fetoscopic Selective Laser Photocoagulation: Fetoscopic laser surgery is used for the treatment of early-onset, advanced-stage twin-twin transfusion syndrome (TTTS). With this procedure, a surgical camera is inserted into the uterus under anesthesia, enabling the proceduralist to see the placenta and blood flow between the twin blood supplies. Using laser, the exchange of blood between the twins is interrupted in order to increase the chances of healthy twin survival.
Fetal shunts: Fetal shunts provide continuous drainage of abnormal fluid accumulations within certain fetal body spaces. They consist of flexible plastic catheters that are guided through the mother’s skin into a fetal location under continuous ultrasound guidance.
Cordocentesis: Cordocentesis refers to the ultrasound-based guidance of an amniocentesis needle into the umbilical vein, which is a main blood vessel within the umbilical cord of a pregnancy. Cordocentesis can be performed for diagnostic and therapeutic purposes, including fetal blood transfusions in cases of severe fetal anemia.
Radiofrequency Ablation: Radiofrequency ablation (RFA) causes thermal (heat-related) injury to tissues using high-frequency radio waves. When applied to the umbilical cord of an abnormal monochorionic twin, RFA can be used to immediately stop blood flow within it. This leads to an intentional demise (loss) of the abnormal twin, while also decreasing risk of permanent neurological (brain) injury or death for a monochorionic co-twin.
Genetic Testing
At the Center for Prenatal Pediatrics, a genetic counselor is available to discuss what an abnormal ultrasound or screening results could mean for your fetus and the pregnancy.
Prenatal genetic counseling provides information and support to people whose fetus is at risk for a genetic disorder. A prenatal genetic counselor meets with you to discuss specific genetic risks, the possibility of chromosome abnormalities or genetic syndromes, as well as genetic testing. There are many reasons to seek prenatal genetic counseling. You may consider it if you:
- Have or are concerned that you may have an inherited disorder
- Are pregnant or planning to be pregnant after age 35
- Already have a child with a genetic disorder or birth defect
- Have had two or more miscarriages
- Have already experienced the loss of a child
Conditions We Care For
The Center for Prenatal Pediatrics provides expert, multidisciplinary care for the following conditions:
Abdomen
- Duodenal Atresia
- Gastroschisis
- Intra-abdominal Cysts and Masses
- Omphalocele
Brain and Spinal Cord
- Agenesis of the Corpus Collosum
- Dandy Walker Malformation and Variants
- Holoprosencephaly
- Spina Bifida
- Ventriculomegaly
Cardiovascular
- Arrhythmia
- Atrioventricular Septal Defect
- Ebstein's Anomaly
- Hypoplastic Left Heart Syndrome (HLHS)
- Tetralogy of Fallot
- Transposition of the Great Arteries
- Truncus Arteriosus
- Ventricular Septal Defect
Chest
- Bronchopulmonary Sequestration
- Congenital Cystic Adenomatoid Malformation
- Congenital Diaphragmatic Hernia
- Esophageal Atresia and Tracheoesophageal Fistula
- Hydrothorax
Face, Hand, and Neck
- Cleft Lip and Palate
- Micrognathia
- Teratoma
Lymphatic System
- Cystic Hygroma
Tissues and Organs
- Hydrops
Multiples
- Conjoined Twins
- Dichorionic Twins
- Monoamniotic Twins
- Monochorionic, Diamniotic Twins
- Twin Reversed Arterial Perfusion Sequence
- Twin-Twin Transfusion Syndrome
- Unequal Placental Sharing
Reproductive and Urinary Systems
- Ambiguous Genitalia
- Bladder Exstrophy
- Hydronephrosis
- Hypospadias
- Lower Urinary Tract Obstruction
- Multicystic Dysplastic Kidney
- Renal Agenesis
- Ureterocele and Duplicated Collecting System
Skeleton and Extremities
- Amniotic Band Syndrome
- Arthrogryposis
- Clubfoot
- Hemivertebrae
- Radial Aplasia
- Skeletal Dysplasia
Our Approach to Care
Your First Visit
You’ll first meet with MFM specialist and a neonatologist, and we will connect you with any other doctors you need. Our coordinators can assist you in arranging these appointments. We do our best to schedule as many appointments in the same day as we can, to minimize the number of visits you need to make to our enter.
Advanced Imaging and Diagnosis
We offer many pregnancy screening tests, including ultrasound, fetal echocardiography, amniocentesis, chorionic villus sampling, cordocentesis (fetal blood sampling), and fetal magnetic resonance imaging (MRI) capabilities to diagnose and clarify complex conditions and help us determine the most appropriate treatment options.
Expertise in Newborn Surgery
Should your baby require surgery shortly after birth, our pediatric surgery program and subspecialty surgical programs are among the strongest in our area. Whenever possible, we perform surgery using minimally invasive techniques (such as laparoscopy and thoracoscopy), resulting in smaller incisions, less discomfort, and a faster recovery for your baby than open surgery.
World-Renowned Care for Fetal Heart Defects
We are particularly well-known for our expertise in pediatric heart surgery, including the care of newborns. Through the NewYork-Presbyterian Congenital Heart Center, our pediatric cardiac surgeons perform more than 700 cardiac operations each year, including some 175 heart repairs in newborn infants. Our surgeons routinely treat some of the most complex cases, many referred from other institutions.
Neonatal Intensive Care Unit
NewYork-Presbyterian neonatal intensive care units (NICUs) are among the busiest and most highly regarded units in the country. At the NewYork-Presbyterian Morgan Stanley Children’s Hospital, our Level IV NICU — the highest level of neonatal care available — cares for critically ill infants, including low birth weight babies, premature babies, infants with respiratory distress, gastrointestinal disorders, congenital abnormalities, and other conditions that may require surgery. Our NICU is designated by the New York State Department of Health’s Bureau of Women’s Health as a Regional Perinatal Center.
Support and Guidance to Transition Home
When your baby is ready to go home, we provide you with guidance and education to prepare you and your family. Social workers and other psychosocial support specialists can help you with any emotional support you may need as you embark on your new lives together. They can also connect you with resources in your own community.
Continuity of Care
Our program provides care for both mother and fetus from the time of prenatal diagnosis through birth and beyond. When the time comes, we can connect you with pediatric specialists to meet your child’s unique needs.
Why Choose Us
Expertise in Maternal-Fetal Medicine
The maternal-fetal medicine program at NewYork-Presbyterian Morgan Stanley Children’s Hospital is among the largest and most experienced programs in the country. Headed by academic leaders with advanced knowledge in pregnancy complications, these experts collaborate with colleagues in neonatology, pediatrics, cardiology, anesthesiology, and surgery to provide care tailored to your individualized needs.
Expertise in Neonatology Care
Our neonatologists have the expertise to care for premature infants, Infants at risk for neurologic injury, infants with conditions such as pulmonary hypertension or chronic lung disease, cardiac anomalies, birth defects, and genetic disorders, employing the latest approaches and technologies that improve the outcomes of the sickest and most fragile infants.
Innovative Approaches and Lifesaving Treatments
NewYork-Presbyterian is nationally recognized for optimizing the health of newborns and minimizing risk in the tiniest, most fragile newborns with our innovative approaches and lifesaving treatments. We have one of the best infant survival rates among NICUs nationally, and the lowest rates of chronic lung disease in the U.S. We are recognized by the National Institutes of Health for excellence and expertise in the gentle ventilation of neonates, the standard of care in early, acute lung disease in extremely preterm infants. Our devotion to your newborn continues long after discharge, with comprehensive neonatal and nutritional follow-up programs to promote your newborn’s growth and development.
Access to World-Class Pediatric Specialists
NewYork-Presbyterian has nationally renowned specialists in every field of pediatrics, so that your child will have access to all of the various pediatric medical and surgical subspecialists they may need. This will ensure that of your child's medical needs can be addressed under one roof.
Seamless Access to Resources and Support Services
At NewYork-Presbyterian, patients and families have seamless access to our vast resources. We also have a Parent-to-Parent program that can connect you personally with a parent whose child has been treated for the condition your child has.