A Good
Beginning

Maternal-fetal medicine physicians work wonders —and make familes whole.

by Delia Ward

At 19 to 21 weeks into pregnancy, many women have an ultrasound to check in on their baby’s growth. Amy Gentzkow, then 33, remembers her appointment all too clearly.

“When they got to looking at her heart, the room got really quiet,” she says. Later, Gentzkow found out her child had a heart defect called tetralogy of Fallot.

Gentzkow, who manages the speech pathology program at the VA, consulted with medically knowledgeable friends and family. “It seemed that the best choice for us was to transition our care to the University of Washington,” she says.

Edith Cheng, M.D., ’87, Res. ’91, Fel. ’93, ’95

Familiarity breeds excellence

The family’s case was taken on by Edith Cheng, M.D. ’87, Res. ’91, Fel. ’93, ’95, a medical geneticist and obstetrician who works with high-risk pregnancies.

Cheng is the medical director of the Maternal and Infant Care Center at UW Medical Center, as well as the medical director of UW Medicine’s Prenatal Genetics and Fetal Therapy Program. To Cheng and her colleagues in maternal-fetal medicine, Gentzkow’s case was serious, but not at all out of the ordinary.

“We have a lot of experience caring for pregnancies complicated by maternal conditions or fetal birth defects.”— Edith Cheng, M.D.

“Our practice at UW Medicine receives a large number of referrals for high-risk pregnancies,” says Cheng. “We have a lot of experience caring for pregnancies complicated by maternal conditions or fetal birth defects.”

Complex structural heart defects, such as that found in Gentzkow’s baby, are routine to Cheng and her colleagues. The clinic also receives referrals for other birth defects, including spina bifida, gastroschisis or other abdominal wall defects, hydrocephalus, and Down syndrome.

Gentzkow found the staff’s familiarity with difficult cases comforting. “I felt the confidence that they had worked with someone like me before, and that it wasn’t abnormal,” she says.

Preventing crises

Children with conditions diagnosed before birth, like Gentzkow’s baby, need specialized care shortly after they’re born. Cheng finds that this post-birth period is stressful for the parents. Not only do the parents have a new child, but they also have to make important decisions about the child’s medical care. And these decisions have to be made during a major transition: from the maternal-fetal medicine team (whom the parents know and trust) to a brand-new medical team that, while capable of providing sophisticated pediatric care, is unfamiliar to the family.

“How do we link these together?” Cheng wondered. “How do we make this a fluid transition for the parents?”

Her answer, in a program developed just a few years ago, was to enhance the quality and timing of collaboration between maternal-fetal medicine and neonatology at UW Medicine and pediatric subspecialists at Seattle Children’s.

Parents now meet early on with Cheng and the appropriate expert (in Gentzkow’s case, a pediatric cardiologist) to talk about the child’s diagnosis, post-delivery care options, and the coordination of the mother’s prenatal care. This meeting is held at Children’s Prenatal Diagnosis and Treatment Center, a block away from Seattle Children’s. Similar meetings with the UW obstetrical and neonatal teams take place at UW Medical Center, where the baby will be delivered. This process is immensely reassuring to parents, and it provides important continuity of care.

 

“In a time of crisis,” says Cheng, “it’s hard for parents to hear what the providers are saying.” With this new system, parents — and providers — have a game plan before the baby is born.

 
 
 

Alumna Edith Cheng, M.D., prepared Amy Gentzkow so well for the post-birth care of her first daughter — diagnosed with a heart defect in utero — that Gentzkow could enjoy her newborn. “The moment I met Mili, I knew everything was going to be okay,” says Gentzkow. Pictured: Mili and Audri Gentzkow, with their mother, Amy, and Edith Cheng.

All photos by Clare McLean

Caring for high-risk mothers

Maternal-fetal physicians like Cheng and her UW Medicine colleagues, who include Zane Brown, M.D., Thomas Easterling, M.D., Fel. ’89, Thomas Benedetti, M.D. ’73, and Michael Gravett, M.D., Res. ’81, Fel. ’83, also take care of mothers whose conditions drive the definition of a high-risk pregnancy.

For the past two decades, says David A. Eschenbach, M.D., Res. ’73, chair of the Department of Obstetrics & Gynecology, UW Medicine has treated some of the region’s most difficult pregnancies. “We got quite good at taking care of mothers with medical complications and developed a reputation of being able to provide excellent care under life-threatening circumstances,” he says.

Cheng’s specialty area, for instance, includes women with special health needs, such as cystic fibrosis, in which nutritional levels and pulmonary function may be compromised. She also sees women with genetic conditions formerly associated with early mortality and women who have had organ transplants.

Zane Brown takes care of pregnancies complicated by the mother’s diabetes, a condition becoming ever more prevalent on the national scene.

“Our diabetic patient population has exploded,” says Eschenbach. Women with poorly controlled diabetes, he says, have babies with high glucose levels. In turn, high glucose levels lead to higher rates of respiratory problems and birth defects. Some of these children were at risk for dying before reaching term at 37 or 38 weeks. As a result, babies of diabetic mothers used to be delivered early, at 35 or 36 weeks. This preterm delivery also posed problems, as the children were at risk for developing serious respiratory problems.

Before their baby is born, parents meet with physicians at UW Medicine and Seattle Children’s; having a treatment plan is immensely reassuring.

Now, with Brown providing guidance on diabetes management to women and community obstetricians, pregnancies can continue to full term. “This makes for a healthier baby,” says Eschenbach.

Thomas Easterling manages women with complex medical conditions, including organ transplantation, heart disease and hypertension, in which the mother’s antihypertensive drugs must be monitored carefully. Easterling and Thomas Benedetti are experts in critical care, and Michael Gravett manages pregnancies at risk for preterm birth, such as twins and triplets.

UW Medicine’s expertise in caring for high-risk mothers means that the maternal-fetal medicine team is in demand. Cheng, Brown, Easterling, Benedetti and Gravett travel to Yakima and other communities in the five-state region of Washington, Wyoming, Alaska, Montana and Idaho to provide consultative care and educate women and providers. Easterling and Brown, in fact, are developing a telemedicine program in which they check in with distant patients who log their blood pressure and glucose-insulin levels.

Knowing the terrain

Developing medical expertise for the Northwest region is part of UW Medicine’s mission, and the Department of Obstetrics and Gynecology offers both a residency (a fouryear program where doctors learn more about obstetrics and gynecology, including the high-risk pregnancies found in the sub-specialty of maternal-fetal medicine), as well as an additional three-year fellowship for maternal-fetal medicine specialists.

Not all ob-gyn residents become maternal-fetal physicians, of course. Still, all the trainees benefit from exposure to high-risk pregnancies.

“You really need to have seen some of these conditions to know that they exist,” says Eschenbach. “You can’t assume that every pregnant woman will have a normal outcome.”

The badge of courage

On May 14, 2009, Mili Gentzkow was born, her heart working well enough for her parents to take her home. Not quite five months later, Mili had open-heart surgery at Seattle Children’s.

The babies Edith Cheng delivered and cared for years ago are now having babies of their own. “It’s a full circle for me,” she says.

Gentzkow is enormously grateful to her doctor. Cheng was an advocate, she took time to answer questions, and “she dealt with my physical and emotional needs incredibly well,” says Gentzkow. And of course, Cheng delivered the goods. Twice, in fact. She also presided over a much less complicated second pregnancy and the birth of another daughter, Audri.

Now three, Mili’s follow-up care includes an annual echocardiogram. After she turns 10, she’ll have another surgery that will replace her pulmonary valve. Otherwise, she’s indistinguishable from other children her age.

“These kids are just like any other kids. They just have little scars,” says Gentzkow. “To Mili, it’s her badge of courage.”

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