in focus

From the earliest days of history up until just a few years ago,  prenatal development is something that has been cloaked in mystery.
Even with the invention of ultrasound, when doctors were first able to look inside a woman’s uterus and spot problems with the fetus, options for treatment were severely limited. Simply put, doctors couldn’t get in there to work.

Options often narrowed down to termination or delivery and comfort care. That is, giving birth to a sick baby and then watching it die in a few days.

“With the advent of ultrasound, you could start to make diagnoses prenatally,” says Dr. Stephen Emery, Lakemont Drive resident and director of the Fetal Diagnosis and Treatment Center at Magee Womens Hospital, “and that information would be useful for planning purposes, but basically we were powerless. We sort of had to stand by and watch the disease unfold. And then the baby’s born, and it survives or it doesn’t.”
Thanks to doctors like Emery, in some cases, this is no longer true.

“There’s been really quite a revolution over the past 20 years of our understanding of the natural history of fetal and newborn diseases,” says Emery. “It used to be that, back in our parents’ days, you got what you got.”

Emery came to Magee from the Cleveland Clinic in 2006 to build UPMC’s fetal treatment program from scratch.

About 10,000 women per year go to Magee to give birth. About 3 percent of those pregnancies are complicated by some type of fetal anomaly. Right now, roughly 5 percent of those complications—about 15 out of 300—are amenable to some type of in utero intervention. Emery and the large pool of talented doctors at UPMC are the revolutionaries who are changing the way fetal diseases can and will be treated in the future.

They are saving babies’ lives before the babies are even born. A combination of amazing technology that includes miniaturization of tools and advances in ultrasound allow doctors like Emery to do things that simply weren’t possible just 10 or 15 years ago.
Here’s an example: When a woman is pregnant with twins who share one placenta, 10 percent of the time a situation occurs where one fetus starts sharing its blood supply with the other fetus. This is not good.

“You’re going to lose both if you don’t do something,” says Dr. Emery.

Emery and his team developed a treatment that involves a scope about as large as the inside of a ballpoint pen and a fiber-optic laser, which is inserted into the uterus. Surgeons, using ultrasound, then find the blood vessels that cause the problem. They then slide the laser through the scope to cauterize the vessels, essentially splitting the twins from the placenta to give them the chance to grow normally.

“Now think about that for a second,” Emery says. “With that simple intervention that basically can be done under an epidural and the mom doesn’t even need a Band-Aid afterwards, you just potentially saved the lives of two twins.”  Surgeons at Magee have done this procedure more than 25 times.
Other life-saving in utero procedures include saving hearts by inserting wires and balloons into the fetus, and partial-birth operations where the head of the baby is birthed, but the rest of it is still connected to the mom, giving surgeons the time to do what they need to do in order to help the baby.
Dr. Emery stresses that “the fetal therapy program is not me. It’s a big giant us” at UPMC that allows for this type of advanced treatment. He says that the program is successful because “people try. People practice, people are interested in doing this. They want to make it happen.”
And with the help of Dr. Emery’s leadership, they are.

Photo by Martha Rial