The Johns Hopkins Center for Fetal Therapy

Amniotic band syndrome is a condition that can affect your developing fetus. During gestation, your fetus develops in the uterine cavity, which is lined by a thin membrane known as the amnion. In rare circumstances, a sheet or band comprised of the amnion can run through the uterine cavity. When this occurs, parts of the fetal body – particularly the limbs – can become entangled. If this entanglement is so tight that blood flow is constructed, fetal development may become affected.

• Overall, amniotic bands have been reported in up to 1 in 1,200 live births. But a much smaller proportion develops amniotic band syndrome.
• We understand the urgency involved with treating amniotic band syndrome. Our care team is available to take your call at any time and will see you as soon as possible.
• The prognosis of amniotic band syndrome depends on the location and severity of the damage caused by the band.
• The treatment options for amniotic band syndrome include fetal surgery and postnatal repair of developmental abnormalities.

If you are pregnant with a monochorionic set of identical twins, your babies will share one placenta. This can sometimes leading to certain complications in the womb, as both babies are predisposed to some vascular instability. This instability can lead to a marked fluctuation in blood pressure or blood flow in the circulation of one twin, which can interfere with the normal development of fetal organs. When one twin experiences a fetal abnormality, this is known as a discordant anomaly.

• We understand the urgency involved in exploring all management options for a fetus with a discordant anomaly. Our care team is available to take your call at any time and will see you as soon as possible.
• Under certain circumstances, fetal anomalies can place the healthy twin at increased risk for preterm delivery.
• Alternatively, a fetal anomaly can be so severe that normal survival after delivery is very unlikely.
• Treatment options vary for discordant anomalies, but may include fetal monitoring and/or fetoscopic laser surgery.

Fetal hydrops refers to the accumulation of fluid in two or more compartments of the body of the fetus. The fluid may be in the chest and abdomen, and sometimes, there is generalized swelling due to fluid accumulating in the tissues. Fetal hydrops can be due to a range of fetal disorders, including those of the blood or heart, fetal infections and more rare conditions that may be genetically inherited.

• Fetal hydrops is a physical marker of other underlying conditions or diseases.
• We understand the urgency involved with treating a fetus with a fetal hydrops diagnosis. Our care team is available to take your call at any time and will see you as soon as possible.
• The outcome for fetal hydrops depends on the underlying cause, the presence of associated genetic conditions, the impact of the fluid on development and body function, and the response to fetal therapy.
• After treatment for fetal hydrops, our patients will have continued access to the most advanced multidisciplinary care at Johns Hopkins, including our fetal, maternal and pediatric specialties.

Fetal hydrothorax refers to the accumulation of fluid within the chest of a fetus. This fluid may be in the space between the lungs and the chest wall (pleural space) or within the substance of the lung or chest masses. Because the chest is an enclosed space, the presence of fluid can result in compression of the lungs and even displace the heart.

Compression of the lungs can interfere with normal development. When this occurs, the lungs may not allow oxygen intake at the normal level, called pulmonary hypoplasia. Displacement of the fetal heart can also occur and interfere with the ability of the heart to receive and pump blood, leading to possible heart failure. When this progresses to cause fluid accumulation in other parts of the fetal body, it is known as fetal hydrops.

• We understand the urgency involved with treating a fetus with a fetal hydrothorax diagnosis. Our care team is available to take your call at any time and will see you as soon as possible.
• The first step in the treatment of fetal hydrothorax is a detailed ultrasound examination that evaluates the fetus for any signs of underlying conditions that may have caused hydrothorax.
• After treatment for fetal hydrothorax, our patients will have continued access to the most advanced multidisciplinary care at Johns Hopkins, including our fetal, maternal and pediatric specialties.

A lower urinary tract obstruction (LUTO) occurs in utero when the flow of urine is blocked from exiting the body at the level of the lower urinary tract, which is comprised of the bladder and urethra. When this occurs, all parts of the urinary tract that lie above the obstruction may become distended with urine that cannot drain. Over time, severe blockage can lead to permanent kidney damage in the fetus. When urine can no longer be excreted, the fluid around the fetus (amniotic fluid) decreases. This can lead to lung damage because the fetus must move the amniotic fluid in and out of the lungs for them to develop normally. Therefore, LUTO can lead to damage in more than one organ system.

• As innovators in fetal surveillance techniques, we offer diagnostic micro-cystoscopy for the early identification of lower urinary tract obstruction.
• The goal of fetal treatment for LUTO is to provide constant drainage of urine from the body into the amniotic fluid in order to avoid buildup of urine and to normalize amniotic fluid volume.
• At the Center for Fetal Therapy, we offer several treatments for LUTO, including vesicocentesis, vesicoamniotic shunt placement, and operative fetal cystoscopy for posterior urethral valves and urethral stenosis.
• After treatment for LUTO, our patients will have continued access to the most advanced multidisciplinary care at Johns Hopkins, including our fetal, maternal and pediatric specialties, as well as our neonatal intensive care unit (NICU). The NICU can perform more testing after birth to figure out the cause of the LUTO or to look for other birth defects or medical problems.

In monochorionic (identical) twin pregnancies, two fetuses share a placenta. Selective intrauterine growth restriction (sIUGR) can occur if the placenta is not evenly apportioned between the twins. Because the placenta provides nourishment necessary for the growth and development of the twins, if there is an imbalance present, one twin may become malnourished. In severe cases of sIUGR, the fetuses share a circulatory system. Abnormal blood flow through the umbilical artery may endanger the survival of the restricted growth twin. Treatment options for sIUGR include surgically removing linked blood vessels and separation of the circulatory system.

• Twin-to-twin transfusion syndrome (TTTS) must be ruled out before diagnosing sIUGR.
• We understand the urgency involved with treating a fetus with a sIUGR diagnosis. Our care team is available to take your call at any time and will see you as soon as possible.
• Fetal therapy treatment options include surgery to remove linked blood vessels.
• After treatment for sIUGR, our patients will have continued access to the most advanced multidisciplinary care at Johns Hopkins, including our fetal, maternal and pediatric specialties.

Twin reversed arterial perfusion (TRAP) is a rare condition of monochorionic (identical) twin pregnancies. It occurs when the cardiac system of one twin does the work of supplying blood for both fetuses. The twin supplying the blood is known as the "pump twin" and develops normally. However, the increased pumping of the heart puts it at risk for cardiac failure. The other twin — known as the “acardiac twin” — lacks a heart or has an un-deformed heart.

The blood flowing to the acardiac twin is reversed, which hinders proper development. Because the acardiac twin fails to fully develop vital organs, survival outside of the womb is not possible without intervention.

• We understand the urgency involved with treating a fetus with a diagnosis of TRAP. Our care team is available to take your call at any time and will see you as soon as possible.
• The Center for Fetal Therapy team may use a fetal echocardiogram to evaluate the heart health of the normally developing pump twin.
• If the acardiac twin is threatening the life of the normally developing twin, then fetal therapy or intervention is recommended.
• Fetal interventions focus on monitoring the heart health of the pump twin and include procedures to stop blood flow to the acardiac twin.