The Johns Hopkins Center for Fetal Therapy is among the top-level caregivers in fetal-maternal medicine, according to a new consensus statement and criteria from the North American Fetal Therapy Network (NAFTNet). The document — the lead author of which, Ahmet Baschat, is the center’s director — outlines care levels based on maternal and fetal risk and resources required to perform procedures based on complexity.

There are three levels of care — level I denotes fetal therapies with low maternal and fetal risk, level II indicates fetal therapies with low or high maternal risk but low neonatal risk, and level III signifies all fetal therapies regardless of risk level. The document also recommends levels of maternal care, neonatal intensive care and pediatric surgical care for each level, with examples of procedures and other considerations.

“That means that a level III center has the highest expertise in fetal treatments, the highest level of care resources for maternal management, the highest level of neonatal care and the pediatric surgical specialties that are required for these conditions,” says Baschat, who worked on the document for six years. “There needs to be synergy among these resources in one institution.”

Along with being level III, the Johns Hopkins center has a full adult hospital and a connected pediatric hospital — a combination that goes beyond the requirements of such a center.

The fetal therapy team sees high volumes, having performed more than 1,000 interventions — with great outcomes — since its founding in 2014, including more than 400 fetal laser surgeries.

The center is also one of five in the country that perform fetoscopic spina bifada surgery, and it has the highest survival rate (86%) for severe diaphragmatic hernias. Johns Hopkins also has a pulmonary hypertension service for neonates as well as a palliative care service for babies.

The fetal therapy center holds regular maternal-fetal medicine conferences and has a simulation program. It also maintains databases of patient cases and complex identical twin cases, both of which can be used for research and to guide treatment.

Baschat expects the document to help enhance patient care across North America.

“I think this document is going to be important for center directors, to have a widely endorsed tool to help them make requests for proper resources,” he says. “That will benefit patients, who this is ultimately about, by giving institutions the tools that are required to care for them.”

Use of the document is voluntary and NAFTNet, of which Johns Hopkins is a steering committee member, does not have governing power over fetal therapy centers. Baschat expects, starting next year, that when fetal therapy centers apply for admission to NAFTNet, they’ll be asked for information on their care resources and procedures they can provide as detailed in the fetal therapy care level consensus statement.

The document is authored by all the major North American Gyn/Ob and pediatric organizations: the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the Society of Obstetricians and Gynaecologists of Canada, the American Pediatric Surgical Association, the Canadian Association of Paediatric Surgeons, the Canadian Paediatric Society, the American Academy of Pediatrics, the American Society of Anesthesiologists and the International Fetal Medicine and Surgery Society.