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Cutting-edge Fetal Surgery Program & Multidisciplinary Care Restores a Mother’s Hope

Every time Maria Elliott* looks into the smiling face of her 13-month-old son Elijah, she is reminded of what helped make it all possible – the extraordinary, multidisciplinary care that she and her baby received at Winthrop-University Hospital.


Martin Chavez, MD, Chief of the Division of Maternal-Fetal Medicine and Director of the Fetal Therapy and Surgery Program at Winthrop.
Mrs. Elliott suffered from Rh Disease during pregnancy – a condition that results when Rhnegative blood is exposed to Rh-positive blood cells, leading to the development of Rh antibodies. During pregnancy, these Rh antibodies travel through the placenta and attack a baby’s red blood cells, posing several complications including severe anemia leading to cardiac failure and fetal death.

Though she was blessed with a healthy child 10 years ago, Mrs. Elliott’s immune response was so intense that hope for any future children was dismal. Despondent in anticipation of the difficult road ahead when she learned that she was pregnant in the fall of 2008, Mrs. Elliott turned to obstetrician/gynecologist Peyman Zandieh, MD, for guidance. Dr. Zandieh works in close collaboration with Winthrop’s Department of Obstetrics and Gynecology and is committed to providing expectant mothers with the best possible care.

“Understanding the severity of Mrs. Elliott’s condition, I knew we needed to act quickly,” said Dr. Zandieh. Confident in the expertise of a dedicated team of Maternal-Fetal Medicine physicians at Winthrop who specialize in the treatment of highrisk pregnancies, Dr. Zandieh promptly referred Mrs. Elliott to the Hospital’s advanced fetal treatment and surgery program. The program offers specialized surgical/treatment modalities to treat a variety of complex fetal conditions.

“With its dedicated team of experts including doctors and nurses who specialize in high risk pregnancy, modern facilities and equipment, and a Neonatal Intensive Care Unit that can support any complication, Winthrop’s comprehensive obstetrical program was the perfect place for Mrs. Elliott,” said Dr. Zandieh.

Upon an initial consultation with Anthony Vintzileos, MD, Chairman of Winthrop’s Department of Obstetrics and Gynecology, and Daniel Kiefer, MD, Ob/Gyn Maternal-Fetal Medicine Fellow, Mrs. Elliott learned of an advanced treatment plan – only available at select hospitals nationwide – that could offer hope for a successful pregnancy. Without this treatment, the chances for fetal hydrops (a serious fetal condition) and early in-utero fetal death would be extremely high.

She was soon evaluated by Martin Chavez, MD, Chief of the Division of Maternal-Fetal Medicine and Director of the Fetal Therapy and Surgery Program at Winthrop, who, with the help of the team, proposed a unique plan of care involving a series of intravenous medical treatments (known as IVIG therapy) and in-utero blood transfusions to treat the baby’s anemia prior to delivery.

“This novel approach enables our team to address anemia problems and treat a fetus in-utero so that the patient’s pregnancy can continue with better outcomes,” said Dr. Chavez, who specializes in high risk pregnancies, ultrasound diagnosis, ultrasound-guided procedures, and fetal therapy, treatment and surgery.

Understanding the need for immediate intervention, Mrs. Elliott began IVIG therapy during the 10th week of her pregnancy. This intravenous treatment utilizes donor blood which provides human-derived antibodies to prevent the mother’s immune system from recognizing a fetus as foreign and attacking it. The first treatment was administered at Winthrop and was a success; subsequent treatments, which averaged six hours in duration, followed on a weekly basis in Mrs. Elliott’s home until approximately the sixth month of her pregnancy.

At 27 weeks, Mrs. Elliott began the second phase of treatment – a series of in-utero blood transfusions. This advanced technique uses ultrasound guided technology to replace fetal red blood cells that are being destroyed by the mother’s immune system. After Mrs. Elliott was administered a medication that would temporarily immobilize her baby, Dr. Chavez used ultrasound technology to guide a needle into the baby’s umbilical cord to transfuse a concentrated amount of healthy blood.

“Fetal umbilical cord transfusion allows for accurate measurements of fetal blood count and exact amounts of blood to be delivered to the baby,” said Dr. Chavez.

Each transfusion was performed in the Hospital’s Labor & Delivery Operating Room with the support of a specially trained team of doctors, nurses and anesthesiologists.

Also instrumental to Mrs. Elliott’s course of treatment was the dedicated efforts of Winthrop’s Blood Bank Team, who worked diligently to ensure the availability and processing of donor blood and platelets necessary for Mrs. Elliott’s in-utero transfusions.


Among the members of Maria Elliott and Elijah’s care team at Winthrop were (l.-r.) Jane Chiusano, MT(ASCP), Blood Bank Supervisor; CJ Catalano, RN, MSN, Nurse Manager, Labor & Delivery; Martin Chavez, MD, Chief of the Division of Maternal- Fetal Medicine and Director of the Fetal Therapy and Surgery Program; Peyman Zandieh, MD; Anthony Vintzileos, MD, Chairman of the Department of Obstetrics and Gynecology; and Nazeeh Hanna, MD, Chief of the Division of Neonatal Medicine.

“We needed a consistent supply of O Rh-negative blood and AB negative platelets – the rarest types of blood and platelets,” said Jane Chiusano, MT (ASCP), Winthrop’s Blood Bank Supervisor. “Thanks to the efforts of the Long Island Blood Services and all of the community members who stepped up to donate, we were able to meet this vital need.”

What’s more, members of the Blood Bank Team received specialized training in order to prepare specified volumes of blood needed for each inutero transfusion.

“It was truly remarkable to witness multiple departments working together to achieve one common goal – helping this mother and baby,” said Ms. Chiusano.

On July 26, 2009, Mrs. Elliott happily welcomed Elijah into the world, delivered by Dr. Zandieh, who co-managed her care throughout the entire pregnancy.

Elijah’s care continued in Winthrop’s Neonatal Intensive Care Unit (NICU), where he was monitored by an outstanding team of neonatologists and nurses for several days before going home with his mom and dad. Though he required some followup treatment, today, Elijah is a vibrant 14-month-old who is making full progress thanks to the extraordinary care that he received at Winthrop.

“When I first found out I was pregnant, I felt hopeless,” said Mrs. Elliott. “Today, I am so thankful to have come across such a wonderful team of specialists at Winthrop, who have truly restored my confidence in healthcare.” Winthrop-University Hospital offers a full range of comprehensive obstetric and gynecological services.

Winthrop is a New York State Regional Perinatal Center – a prestigious designation that recognizes the Hospital’s commitment to delivering the highest level of obstetrical and perinatal care. For more information about obstetrical and gynecological services at Winthrop, call 1-866-WINTHROP

*patient’s name has been changed to respect her privacy.
Vol. 20, No. 2
Summer/Fall 2010

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