In-utero surgeries offered at The Fetal Center

• Our nationally-recognized high volume Fetal Center, whose multidisciplinary team of maternal fetal medicine specialists along with their associated expert teams of specialized physicians, see many patients with TTTS and spina bifida annually. If patient consented, patients are followed closely not only until discharge but well into their first years of life. By doing so, and following the careful analysis of patient data, they are able to make meaningful and timeous improvements to outcomes for both conditions. This is achieved in various ways. The first is by independently evaluating data as a center and then publishing those findings in peer-reviewed journals, and the second is by corroborating and collaborating with other fetal care centers through networks such as the North American Fetal Therapy Network (NAFTNET); a group of medical centers in the United States and Canada with established expertise in fetal surgery and care for complex disorders of the unborn baby. If you would like to obtain additional information about these studies, please contact the TTTS registry’s Principal Investigator, Ramesha Papanna, MD, MPH, at ramesha.papanna@uth.tmc.edu or at 832-500-6423, or the spina bifida registry’s Principal Investigator, Kuojen Tsao, MD, at kuojen.tsao@uth.tmc.edu or at 713-500-7300.

• TTTS patients may also consent to the “Pediatric neurodevelopmental outcomes in twin-twin transfusion syndrome” study. The purpose of this study is to evaluate long-term pediatric neurodevelopmental outcomes in identical twins who underwent in-utero fetal surgery for TTTS at The Fetal Center at Children’s Memorial Hermann Hospital. Should a patient consent to this study, they’ll be asked to complete standardized and widely-accepted questionnaires aimed at screening for autism, neurodevelopmental and motor deficiencies up until the age of three years old. These results are read by the Fetal Center’s maternal-fetal medicine specialist and Principal Investigator of the study, Eric Bergh, MD, who lets parents know if there is any reason for developmental concern. For more information about these studies, please contact Dr. Bergh at eric.p.bergh@uth.tmc.edu or at 713-500-6412.

Multi-center collaborative review of pregnant women undergoing fetoscopic laser surgery (FLS) for Twin-Twin Transfusion syndrome (TTTS) with a short cervical length:

• Despite the success of fetoscopic laser surgery (FLS) for severe twin-twin transfusion syndrome, preterm delivery continues to be a challenge and determines perinatal survival and morbidity. The average gestational age at delivery after FLS for TTTS ranges from 29 weeks to 33 weeks, compared to 36-37 weeks in healthy monochorionic twin pregnancies. The factors that have been associated with preterm delivery after FLS for TTTS includes a short cervical length, post-operative fetal membrane separation at the site of entry and preterm premature rupture of membranes. The primary objective is to evaluate the use of a cervical pessary, vaginal progesterone, cervical pessary in combination with progesterone and no treatment in women who underwent FLS for TTTS with a short cervical length of less than 30 mm. For more questions about this study, please contact the Principal Investigator, Ramesha Papanna, MD, MPH, at ramesha.papanna@uth.tmc.edu or at 832-500-6423.