Maternal-Fetal Medicine

Aviva Lee-Parritz, M.D., Medical Director

MISSION

The mission of the Center for Labor and Birth is to provide an environment for excellence in clinical care, innovative education and support a productive clinical research program.

Over 10,127 deliveries took place in our unit, representing a 1.2% increase over last year. Over 15,000 patients were seen in our obstetric triage area, presenting with a wide variety of obstetrical, medical and surgical issues during pregnancy. In addition to providing obstetric care for our surrounding community, we have continued to be a growing referral source for tertiary care for hospitals in the greater New England area.

GOALS AND ACCOMPLISHMENTS FOR AY 2001-2002

Research

• Dr. Tom McElrath is leading the BWH site for the ELGAN (Extremely Low Gestational Age Neonate) study. This is a multicenter trial examining the role of protein determinants of adverse neurological outcomes in premature infants.
• Dr. James Greenberg is leading BOPPS (Boston Postpartum Pain Study), which evaluates different types of suture used for perineal repair after vaginal delivery and subsequent pain and healing.
• Dr. Daniela Carusi is completing a retrospective study of the safety and efficacy of misoprostol as a cervical ripening agent.
• Completion of data acquisition for the FOCUS trial (Fetal Orientation in Childbirth by Ultrasound) under the direction of Dr. Ellice Lieberman from the Center for Perinatal Research. The FOCUS trial examines the interaction of fetal position in labor, epidural analgesia and delivery outcomes.
• Continuation of the VIVA trial with Harvard Vanguard Associates, which studies effects prenatal diet on the mother and child.
• Cord blood and placental tissue is being collected after deliveries to study a variety of medical conditions including inflammation, stem cell biology and fetal anomalies.
• Planning is in progress for development of a maternal-fetal-neonatal tissue bank to enable researchers to examine complex interactions such as the fetal inflammatory response that may elucidate the pathophysiology that leads to preterm delivery.

Education

• The Center for Labor and Birth is a resource for innovative clinical education for a variety of trainees, including fellows in Maternal-Fetal Medicine, residents in Obstetrics and Gynecology, medical students, nurses and nurse-midwifery students. In addition, we continue to be an adjunct training site for MedFlight technicians. There is an active continuing education and certification program for nurses, highlighting the unique medical complications seen in our referral population. The staff in the Center for Labor and Birth is committed to clinical teaching and continues to be recognized with citations and awards.

Clinical

• The Center for Labor and Birth provides the highest quality family focused and culturally sensitive obstetrics care in our state-of-the-art environment.
• As part of an effort of the entire Center for Women and Newborns, we are enhancing security for families and their newborns.
• The Center for Labor and Birth is a premier setting for management of complications of pregnancy; antepartum, intrapartum and post delivery. Our center focuses on the complexities of maternal and fetal complications of pregnancy. We care for a large population of mothers with diabetes mellitus, hypertension cardiovascular, collagen vascular and immunologic disease. Working closely with cardiologists at Children’s Hospital we have developed special expertise in caring for mothers with corrected congenital heart disease. In addition, many patients deliver in our center with complex fetal conditions including congenital anomalies, growth abnormalities, complications of multiple gestations and isoimmunization. In conjunction with the Antenatal Diagnostic Center and surgeons from Children’s Hospital, our staff participates in the planning and implementation of in-utero fetal therapies.
• We have added new areas to care for our patients undergoing procedures for pregnancy loss, so that their care can be rendered in the same excellent clinical care setting without immediate exposure to laboring women and newborns.

GOALS FOR AY 2002-2003

• Expansion our research programs, including research in collaboration with obstetric anesthesia, perinatal epidemiology and neonatology, as well other divisions throughout the hospital.
• Reporting on our experience delivering a large number of women with corrected congenital heart disease.
• Reduction of infectious morbidity in the obstetric setting.
• Striving towards creating a research infrastructure to enable clinicians and trainees to participate in clinical research.
• Improvement of computerized scheduling and data collection of obstetric patients.
• Improvement of obstetric education, with the focus on evidence based interactive core curriculum and evaluation of mastery of clinical skills during resident training.
• Continuing development of clinical management guidelines, documentation and error prevention programs.
• Increasing efficiency and optimal use of resources in the Labor and Delivery Unit.

(taken from the Department of Ob/Gyn 2001-02 Annual Report)