Department of Gynecology & Obstetrics, Johns Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland; the Department of Obstetrics, Gynecology & Reproductive Sciences and the Division of Pediatric General and Thoracic Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; the Department of Anesthesiology, Children's Hospital Colorado/Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado; the Department of Pediatrics & Bioethics, Albany Medical College, Albany, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Pediatric, General, Thoracic and Fetal Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, California; the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, and the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; the Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; the Department of Surgery, Warren Alpert Medical School of Brown University, and Hasbro Children's Hospital, Providence; Rhode Island; the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina; the Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; the Division of Pediatric Cardiology, Department of Clinical Pediatrics, and the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; the Division of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; the Department of Surgery, Centre for Surgical Research, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; the Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Yale University School of Nursing, Orange, Connecticut; and the Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Obstet Gynecol. 2022 Jun 1;139(6):1027-1042. doi: 10.1097/AOG.0000000000004793. Epub 2022 May 2.
Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties. Three care levels for fetal therapy centers are proposed to match the anticipated care complexity, with appropriate resources to achieve an optimal outcome at an institutional and regional level. A level I fetal therapy center should be capable of offering fetal interventions that may be associated with obstetric risks of preterm birth or membrane rupture but that would be very unlikely to require maternal medical subspecialty or intensive care, with neonatal risks not exceeding those of moderate prematurity. A level II center should have the incremental capacity to provide maternal intensive care and to manage extreme neonatal prematurity. A level III therapy center should offer the full range of fetal interventions (including open fetal surgery) and be able manage any of the associated maternal complications and comorbidities, as well as have access to neonatal and pediatric surgical intervention including indicated surgery for neonates with congenital anomalies.
为改善胎儿结局或优化向新生儿期过渡而进行的胎儿治疗通常会带来一定程度的母胎或新生儿风险。胎儿治疗中心需要获得资源来开展此类治疗，并管理可能出现的与治疗本身相关或与胎儿或母体基础疾病相关的母胎和新生儿并发症。因此，胎儿治疗中心需要专门的运营基础设施和必要的资源，以便对临床绩效进行适当的监督和监测，并促进相关专业之间的多学科合作。为了匹配预期的护理复杂性，提出了三级胎儿治疗中心护理级别，并配备了适当的资源，以在机构和区域层面实现最佳结果。一级胎儿治疗中心应能够提供可能与早产或胎膜早破相关的产科风险的胎儿干预，但不太可能需要母体医学亚专科或重症监护，新生儿风险不超过中度早产。二级中心应具有提供母体重症监护和管理极端早产的增量能力。三级治疗中心应提供全面的胎儿干预（包括开放性胎儿手术），并能够管理任何相关的母体并发症和合并症，以及获得新生儿和儿科手术干预，包括对有先天性异常的新生儿进行有指征的手术。
