Last March, the University of South Florida rolled out a new service in partnership with Tampa General Hospital: the USF Health Fetal Care Center of Tampa Bay.

 

The first year of operation has been a banner one, highlighted by the medical team’s successful completion of the area’s first Ex Utero Intrapartum Treatment (EXIT) procedure on Oct. 1, which successfully secured an airway for a baby girl with cystic hygroma, allowing the interdisciplinary group of specialists to deliver the 7-pound, 11-ounce infant by Cesarean section.

 

“We’ve accomplished many goals of the initial design principles,” said Victoria Belogolovkin, MD, medical director of the USF Health Fetal Care Center of Tampa Bay. “We wanted to offer patients comprehensive care from a fetal standpoint, and interventions where appropriate, in one place.”

 

The USF-TGH partnership brings together maternal-fetal medicine specialists, neonatologists, pediatric surgeons, pediatric radiologists, pediatric cardiologists, pediatric neurologists, geneticists, and many other healthcare specialists to provide specifically designed care to mothers whose pregnancies are complicated by illness or fetal abnormalities.

 

Maternal-fetal medicine specialists represent the point-of-entry care for patients with fetal and maternal abnormalities. Perinatal navigator Patty Bornick, RN, MSN, coordinates patient care, education and support.

 

“Ours is a referral center, yet we not only provide primary management of difficult fetal conditions, we also see patients in consultation, provide information, help with diagnosis, and provide appropriate fetal intervention as indicated so patients can return to their primary care provider with a mutually agreed-upon plan,” explained Belogolovkin.

 

Valerie Whiteman, MD, an assistant professor of obstetrics and gynecology at USF who was appointed interim director of Maternal Fetal Medicine for USF Health last spring, manages the medical and surgical complications of pregnancy. “Even though most pregnancies progress smoothly and we’re giving good news, there are times we have to be the bearer of bad news, which requires additional care during the pregnancy or shortly after the baby is born,” she said. “The best way to manage this is for the mother and family to have access to specially-trained physicians like Dr. Belogolovkin and myself and other specialists in close proximity. We know that a normal pregnancy can be disruptive to family life anyway. A pregnancy with complications can be quite disruptive. The goal is to provide the highest standard of care to the mother and unborn baby, and the baby after it is delivered.”

 

Whiteman was the lead USF obstetrician for the successful EXIT specialized surgical procedure, which had only been performed about 100 times in the United States. The 31-year-old patient, whose family has a strong medical background, told Whiteman they had never seen a group of physicians work together so harmoniously, with all team members in total sync.

 

“The USF Health Fetal Care Center of Tampa Bay provided the backdrop to make it possible,” said Whiteman, adding that the support of USF-TGH administration—and the teamwork mindset—made it easier to facilitate the procedure. “When you have a role like that, you need to be able to not only handle everyone’s skill sets, but also their personalities, and it takes a lot of experience and interpersonal care to be interactional between a group of professionals. Everyone wanted what was best for the patient; there were no egos in the OR.”

 

For example, to prepare for the EXIT procedure, the USF-TGH team established protocols and contingency plans for the surgery and practiced with two dry runs in the operating room in August and September.

 

“We set up the process with a successful outcome in mind, and then determined the steps needed to fill in to get to that specific positive end,” she said. “We were working backwards through the entire (trial run) process.”

 

USF attracted Whiteman from Temple Hospital in Philadelphia, Pa., where she was head of obstetrics. She initially pursued sub-specialty training in maternal-fetal medicine during the late 1980s, when many changes were taking place in medicine.

 

“It dawned on me that so much needed to be learned and understood about complications during pregnancy,” she explained. “Some medications you can’t use when you’re pregnant, because the second patient can’t tolerate it, or it might damage the second patient. I liked the idea of walking along the tightrope and dealing with difficult circumstances.”

 

Now that the USF Fetal Care Center of Tampa Bay has been successfully launched, Belogolovkin and Whiteman are turning their attention to the maternal counterpart now in the development stages—the USF Health Maternal Care Center of Tampa Bay.

 

“It’ll be directed toward providing a similar team approach for moms with pre-existing medical conditions, such as cardiac or neurologic conditions or diabetes prior to the pregnancy, or other significant medical complications during the pregnancy. That’s my niche,” said Whiteman. “Then, one person does the fetal side; another person handles the maternal side. It’s a marriage made in heaven.”

 

The USF Health Maternal Care Center of Tampa Bay is expected to open in 2011.