The Advanced Obstetric Surgery Center is proud to provide patients at risk for complications like placenta accreta spectrum, placenta previa, prior hemorrhage and other complex conditions with specialized care. Our physicians are equipped with the expertise to assist patients with sonographic and imaging management throughout pregnancy and perioperative and surgical management through delivery and postnatal care.
Cervical insufficiency (formerly called an incompetent cervix), is a condition where your cervix becomes short or opens earlier than it should during a pregnancy. This unfortunately can lead to losing a pregnancy or delivering preterm, which can put a baby and mother at risk of health issues as well. A Johns Hopkins maternal-fetal medicine expert discusses the current evidence to diagnose cervical insufficiency and the treatments available to help, including cervical cerclage.
Placenta accreta spectrum is a spectrum of disease where the placenta grows into the uterus or other nearby organs. This serious condition requires a cesarean hysterectomy to treat. In this animation by Jason Brady, you can see a depiction of placenta accreta spectrum and how it can affect individuals in pregnancy.
Our center combines the multidisciplinary expertise of maternal-fetal medicine, imaging specialists, and anesthesia care. We also have access to specialized surgeons and care throughout the Johns Hopkins Healthcare system in order to provide critical care directed expertise.
A surgical specialist in maternal-fetal medicine will lead your care from our outpatient practice and imaging center to the operating room. Our MFM surgeons are board certified in surgical critical care, allowing them a full understanding of maternal perioperative care.
We offer preterm counseling including lactation consults for preemie moms, recovery in labor and delivery among your peers, and the option for care partners to stay with you during birth and recovery.
For patients who live far away from Baltimore, we offer the option to work with your primary OB/GYN throughout your pregnancy, delivery, and post-op care. Telemedicine options may be available prior to delivery.
Conditions We Treat and Specialized Care We Provide:
Placenta accreta spectrum is a spectrum of disease where the placenta grows into the uterus during fetal development, invading into the muscles of the uterus or sometimes other organs. Placenta accreta can be fatal, but the survival rate is drastically improved with fetal monitoring and management combined with surgical intervention in the form of a cesarean hysterectomy (a c-section and hysterectomy) upon delivery.
We are ready to help you make a treatment plan with:
Placenta previa is a condition where the placenta grows in a location which blocks the cervix, the opening through which the baby must pass to reach the birth canal during delivery. Placenta previa can cause bleeding throughout pregnancy and typically causes heavy bleeding during birth due to tearing as the cervix naturally expands to allow for the baby to pass through. This expansion can cause the placenta to tear away from the uterus putting both mom and baby at risk. Monitoring and surgical intervention may be necessary to achieve the best possible outcome for both mom and baby during delivery.
Vasa previa is a condition in which the blood vessels that connect the placenta and the fetus (to allow nutrients to reach the fetus from the placenta) grow over the opening of the cervix, blocking it. The cervix is the the opening through which the baby must pass to reach the birth canal during delivery. With vasa previa those blood vessels blocking the cervix can tear during birth, causing heavy bleeding which places both mom and baby at risk. Monitoring and surgical intervention may be necessary to achieve the best possible outcome for both mom and baby during delivery.
Patients with a history of prior hemorrhage, or excessive bleeding within the first twenty four hours to two weeks after birth, may be at higher risk for hemorrhage in later pregnancies. Monitoring and surgical intervention may be necessary to achieve the best possible outcome for both mom and baby during delivery.
Patients with a history of abdominal surgery, especially in cases of multiple surgeries, may be at higher risk for heavy bleeding during a traditional delivery. Monitoring and surgical intervention may be necessary to achieve the best possible outcome for both mom and baby during delivery.
Team surgeries are available for patients that require dual or multiple surgical specialties for the safe delivery of their baby. For example, patients who have undergone complex urologic surgeries may require a team delivery - with both a maternal-fetal medicine surgeon to help safely deliver baby and a urological surgeon to address any urologic concerns that may arise with mom during delivery.
For patients who have received prior surgeries where inserting a mesh was necessary, for example for certain pelvic floor disorders, there may increased risk of tearing or bleeding during delivery. In some cases surgical intervention may be necessary in order to achieve the best possible outcome for both mom and baby.
Patients with a history of surgery for Crohn's and ulcerative colitis or for inflammatory bowel disease may be at an increased risk for complications during pregnancy and delivery. These patients may benefit from additional monitoring throughout pregnancy as well as surgical delivery.
An abdominal cerclage is an advanced surgery that can help achieve a successful pregnancy when other options have not been beneficial, or prior surgeries have affected the cervix substantially. It involves placement of a suture around the cervix, at its highest point where it meets the uterus ("womb"), which is best approached via an abdominal surgery. In appropriate candidates, this surgery can be a significant aid towards achieving a live birth.
Expertise: Complex Obstetric Surgery, Critical Care Medicine, Maternal and Fetal Medicine, Obstetrics, Placenta Accreta Spectrum (PAS)
Expertise: Abdominal Imaging, Diagnostic Radiology, Gynecological Imaging, Magnetic Resonance Imaging (MRI)
Expertise: Diagnostic Radiology, Image-Guided Interventional Procedures, Magnetic Resonance Imaging (MRI), Oncologic Imaging, Prostate Cancer
Expertise: Abnormal Uterine Bleeding, Angiography, Angioplasty, Arteriovenous Fistulas (AVF), Arteriovenous Malformations (AVM)
Expertise: Anesthesiology, Obstetric Anesthesiology
Perinatal Nurse Manager
Johns Hopkins Hospital
600 North Wolfe St
Nelson/Harvey Building, 2nd Floor
Baltimore, MD 21287
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Request an Appointment: 443-997-0400
