Colorado Fetal Care Center Healthcare Professional Resources

The following are general criteria for fetal surgery eligibility. We're happy to discuss specific patient criteria. Our team welcomes consults and referrals for all babies with CDH, regardless of in-utero intervention eligibility.  

Inclusion criteria  

• Severe pulmonary hypoplasia as defined by observed to expected lung to head ratio (O/E LHR)  
• Left CDH: ≤25% 
• Right CDH: ≤45%  
• Diagnosed sufficiently early to permit a procedure between 27 and 31 weeks gestation  
• No significant fetal genetic abnormalities identified by amniocentesis  
• Maternal age of at least 18 years  
• Ability to relocate to the Denver area 

Exclusion criteria 

• Multi-fetal gestation  
• Additional fetal anatomic anomalies diagnosed by ultrasound, MRI or echocardiogram  
• Significant genetic abnormality diagnosed by amniocentesis  
• Short cervix  
• Latex allergy  
• Other maternal medical condition precluding fetal surgery 

The following are general criteria for fetal surgical eligibility. We're happy to discuss specific criteria with you. 

Twin-twin transfusion syndrome (TTTS)  

A laser procedure can improve the outcomes for multiples with TTTS.  

We recommend evaluation and a possible procedure in the following instances:  

•  Stage II to stage IV TTTS 
•  Gestational age between 16 weeks and 26 weeks and 6 days  
•  Stage I TTTS with any of the following:  
  •  Severe polyhydramnios  
  •  Short cervix  
  •  Cardiac dysfunction in either fetus  

Selective fetal growth restriction (sIUGR/sFGR) 

Treatment options include radiofrequency ablation and a laser procedure. 

We recommend evaluation and possible procedure in the following instances: 

• Abnormal Dopplers in the IUGR/FGR fetus (umbilical artery absent, reversed end diastolic flow or abnormal ductus venosus)  
• Evidence of cardiac compromise in either fetus  
• Evidence of concurrent TTTS 

Twin reversed arterial perfusion (TRAP) 

Treatment options include interstitial laser (performed in first trimester), radiofrequency ablation (after 16 weeks), and cord coagulation (monoamniotic).  

We recommend evaluation and a possible procedure in the following instances: 

• Acardiac fetus measures at least 40% of the estimated size of the pump fetus  
• Signs of cardiac compromise in the pump fetus:  
  • Elevated cardiothoracic ratio  
  • Thickened heart muscle  
  • Cardiac valvular insufficiency  
  • Abnormal UA or DV Doppler study  
  • Elevated MCA Dopplers  
  • Polyhydramnios  
  • Cord entanglement 

Twin anemia polycythemia sequence (TAPS) 

Treatment options include a laser procedure, radiofrequency ablation or transfusion.  

We recommend evaluation and a possible procedure in the following instances: 

• Stage III or Stage IV TAPS (evidence of cardiac dysfunction and UA Doppler abnormalities in either fetus)  
• Stage I or Stage II TAPS with additional signs of fetal compromise  
• Evidence of concurrent TTTS 

We proudly offer both fetoscopic and open surgical approaches and welcome referrals for all babies with MMC, regardless of in-utero intervention eligibility. We typically offer both techniques to families and work collaboratively to determine the most appropriate approach for each family. The following are general criteria for fetal surgical eligibility. We are happy to discuss specific patient criteria. 

Inclusion criteria  

• Singleton pregnancy (one fetus)  
• MMC with upper boundary located below T1 Chiari II malformation with hindbrain herniation confirmed by MRI  
• Amniocentesis with absence of significant genetic abnormality  
• No additional significant fetal anomalies 
• Gestational age at the time of the procedure between 23 weeks and 26 weeks and 6 days 

Exclusion criteria 

• Fetal anomaly unrelated to MMC  
• Severe kyphosis  
• Increased risk for preterm birth including: short cervix in current pregnancy (< 1.5 cm) or history of spontaneous preterm birth  
• Placental abnormalities (previa, abruption, accreta) known at the time of evaluation  
• Pre-pregnancy body-mass index ≥40  
• Significant uterine anomaly  
• Maternal-fetal Rh alloimmunization, Kell sensitization or neonatal alloimmune thrombocytopenia affecting the current pregnancy  
• Significant maternal medical conditions  
• Maternal HIV, hepatitis-B or hepatitis-C