Expanding Access to Fetal Telecardiology During the COVID-19 Pandemic.

Background: This study aims to describe one center's experience in expanding a fetal telecardiology program through collaborative work with maternal fetal medicine (MFM) clinics with the goal of safely reaching mothers during the COVID-19 pandemic. We sought to define the extent of fetal telehealth conversion at a large fetal cardiac care center and evaluate the diagnostic accuracy for studies performed. Methods: At our center, fetal telemedicine expanded from one MFM site before the pandemic to four additional sites by May 2020. A retrospective review of fetal telecardiology visits between March 15 and July 15, 2020, was performed. The chart was reviewed for confirmation of diagnosis postnatally. Results: With pandemic onset, there was a large increase in the number of telemedicine visits with a total of 122 mothers seen between five MFM clinics. Fourteen mothers (11.5%) had abnormal fetal echocardiograms requiring additional follow-up, and seven mothers (5.8%) had a fetal echocardiogram suspicious for a critical congenital heart disease (CCHD). All the fetal echocardiograms suspicious for CCHD were confirmed on postnatal echocardiogram. To our knowledge, none of the normal fetal echocardiograms were found to have congenital heart disease postnatally. Conclusions: In response to the COVID-19 pandemic, we rapidly transitioned to fetal telecardiology using a variety of formats. This has reduced potential infectious exposure for pregnant mothers and minimized contact between physicians without compromising diagnostic accuracy. In our experience, the expansion of a telemedicine program requires strong initial infrastructure, prior relationships with MFM providers, and appropriate training among obstetric sonographers.

Delayed-interval delivery in twin pregnancies.

OBJECTIVE: To report on pregnancy outcome in six twin pregnancies with delayed-interval delivery in a single maternal-fetal medicine practice. STUDY DESIGN: All cases of attempted delayed-interval delivery from January 1988 to August 2000 in a single maternal-fetal medicine practice were retrospectively reviewed. Patients were managed with a treatment protocol that included rescue cerclage after delivery of the first born twin, antibiotics, corticosteroids and tocolysis. RESULTS: Five of the six twin gestations resulted in viable birth of the second-born twin. One pregnancy had loss of both fetuses before viability. All first-born twins were nonviable. The median pregnancy prolongation achieved following delivery of the first-born, nonviable twin was 93 days, with a range of 23-153. Three of the five viable, second-born twins had a neonatal intensive care nursery stay of 3, 4 and 35 days (mean, 8.4). No infant required a ventilator. CONCLUSION: Based on our analysis of these six cases, the pregnancy prolongation gained resulted in a clinically significant benefit to the second-born twin, without significant morbidity in the mother.