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Managing the high-risk pregnancy

Most pregnant women continue to see their general OB/GYN for prenatal care throughout the entire nine months and delivery. But a woman who has an underlying medical condition, or develops a pregnancy complication affecting her body or the fetus, may benefit from expert subspecialist treatment by a board- certified maternal-fetal medicine specialist. This physician, also called a perinatologist, has completed a three-year fellowship in maternal-fetal medicine after medical school and a four-year OB/GYN residency.

At Westchester Medical Center, four maternal-fetal medicine specialists care for expectant mothers with prior medical conditions—for example, diabetes, heart disease or kidney disease—or health problems that result from pregnancy, such as gestational diabetes or preeclampsia (toxemia), a potentially life-threatening type of high blood pressure.

They also manage healthy mothers carrying multiple fetuses or those who have experienced prior preterm labor or delivery, recurrent miscarriages or premature rupture of the membranes, in which the amniotic sac has broken before onset of labor. If the fetus is diagnosed with a genetic or anatomic abnormality, maternal-fetal medicine specialists can oversee her care through to delivery or, in some cases, help the expectant mother decide whether to continue the pregnancy, the physician can also coordinate any specialized neonatal services, such as heart surgery, that the infant may require before or after birth. Maternal- fetal medicine specialists also perform diagnostic sonograms and chorionic villus sampling and amniocentesis to diagnose genetic abnormalities in the fetus.

“As part of our regional perinatal program, our maternal-fetal specialists do consultations for their regional colleagues in obstetrics and care for the highest-risk mothers and babies in a seven-county region that includes 13 affiliate hospitals within a two-hour radius,” says James Smith, M.D., Chief of Perinatal Medicine and a professor of clinical obstetrics and gynecology at New York Medical College.

About 1,000 babies were born from high-risk pregnancies at the medical center in 2009—most women with relatively uncomplicated pregnancies don’t deliver there. “We believe that a birth close to home is best, so our doctors go on site to our partner hospitals to provide prenatal care to mothers,” says Dr. Smith. “Most of our mothers can have their babies delivered by their local obstetricians at their community hospitals, where they are close to their homes, families and support systems. The others, who need higher-level care, come to Westchester Medical Center when it’s time to deliver. The decision is based on the baby’s gestational age and the capabilities of the local hospital and the medical staff.”

If a woman’s doctor has already determined that her fetus will need advanced medical care at the center’s 40-bed Regional Neonatal Intensive Care Unit (RNICU), the mother usually comes to Westchester when labor begins or the time for a scheduled induction or Cesarean section nears. For newborns who need to get to the Regional NICU promptly from other hospitals, Westchester Medical Center has the only full-service, 24/7 helicopter and ground high-risk neonatal transport program between New York City and Albany. It brings critically ill, very early preterm babies (some as early as 23 weeks’ gestation) or low-birth weight babies (under 1,000 grams, about 2.2 pounds) to the medical center after they’re born.

Specialized care at The Regional NICU at Maria Fareri Children’s Hospital at Westchester Medical Center has board-certified neonatologists —pediatricians who have completed an additional three-year fellowship in intensive-care treatment of newborns—on site around the clock to care for these vulnerable babies. They and neonatologists who staff the NICUs and special care nurseries at nine affiliated hospitals provide coordinated clinical services based at the Regional NICU. The facility itself has 21 staff neonatologists plus 14 advanced training neonatal fellows, 12 nurse practitioners and more than 140 nurses. Neonatologists from throughout the region rotate through the Regional NICU to ensure the highest level of coordination of the complex medical care provided to the most critically ill newborns.

The Regional NICU treats about 720 babies each year—roughly 500 who are born at the medical center and 220 others who are transported there from other hospitals.

“We see each affiliate hospital as a different room of our home Regional NICU,” says Edmund F. La Gamma, M.D., Director of the Division of Newborn Medicine, Director of the Regional NICU at Maria Fareri Children’s Hospital and a professor of pediatrics, biochemistry and molecular biology at New York Medical College. “We pride ourselves on a seamless integration of services. This makes it easy to transfer babies back to their community hospitals when they are ready and fully able to transition to step- down care in preparation for going home. It’s better for the whole family if their baby is closer to where the family lives during convalescence and growth, because some extremely premature neonates may require hospitalization for more than a month.”

Dr. La Gamma and his team work closely with neonatologist Jordan Kase, M.D., Director of the High-Risk Neonatal
Follow-Up Program, to monitor and provide medical and rehabilitative care for 80 percent of all Regional NICU “graduates” at six clinics throughout the region.

“Through our regional healthcare services, outreach education and public health initiatives, we have improved access to high-level neonatal and perinatal services, improved survival rates for tiny preterm babies to 80 percent for those weighing 750 grams [1.65 pounds], and lowered the occurrence of chronic lung disease in our patients to 20 percent, while the national average is 60 percent for the tiniest patients,” says Dr. La Gamma.

The highest level of perinatal care

To earn its level IV designation, the regional neonatal intensive care unit at Maria Fareri Children’s Hospital at Westchester Medical Center must provide comprehensive services that go beyond what is offered at community hospitals that provide obstetrical and newborn care, including:

  • a neonatal intensive care unit in a teaching hospital or academic medical center
  • consultations from maternal-fetal medicine specialists plus in utero procedures
  • maternal and neonatal technology that is the highest level available
  • maternal and neonatal transport services
  • methods to ensure top-notch quality of newborn care in its affiliated hospitals
  • a full range of pediatric subspecialty care, including cardiac and other pediatric
  • surgical subspecialties, extracorporeal membrane oxygenation (ecmo) for babies whose hearts and lungs are not functioning, and “cool caps” to induce hypothermia in infants’ brains to inhibit or decrease permanent brain damage, with every form of ventilation support available.
  • data collection and assessment, individual case presentations, educational training for physicians at affiliated hospitals and data collaboration with public health agencies
  • ongoing research into the mechanisms of perinatal diseases to develop ever-improved methods of rendering healthcare, including regional services and outreach programs

For more information about the care for HIGH-RISK PREGNANCIES at Westchester Medical Center , please call 914-493-2250 or visit www.worldclassmedicine.com/OBGYN. To learn more about our Regional NICU and Perinatal Center, visit www.worldclassmedicine.com/RPC.

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