Robert Wood Johnson Medicine • Spring 2011 • Population Science

The Winik Family
H ealthy and happy today, twins Claire and Charlie
Winik and their mother, Laura, had extraordinary care from
a village of specialists at RWJMS and RWJUH. Seen here
with her husband, Adam, and the twins, Mrs. Winik received
her obstetric care from the maternal-fetal medicine team.
A pre-existing brain shunt failed in her 35th week, necessitating
emergency care and specialized surgery. Within days,
Mrs. Winik developed pre-eclampsia and required a cesarean
section. The ICU team saw her through to complete recovery,
while the twins were cared for in the NICU.
MFM specialists can treat most of these conditions without
sending the mother to another specialist, for example a cardiologist,
endocrinologist, or neurologist. As high-risk
obstetricians, Dr. Rosen and his team can generally make
necessary adjustments or substitutions in medications that
control heart disease, hypertension, diabetes, or seizures.
The health of mother and fetus is tracked at the center
through regular diagnostic screening and testing that
includes additional ultrasound — with both three- and
four-dimensional imaging — amniocentesis and chorionic
villus sampling for Down syndrome and trisomy 18, fetal
blood sampling, and fetal echocardiography.
Babies in utero are not immune to infection. The virus
that causes fifth disease might give the mother only a mild
rash, but it can cause serious problems for the fetus, including
anemia or birth defects. Fetal testing can reveal the
presence of infection, providing the perinatal team with the
information it needs to treat the baby in utero or to plan
JOHN EMERSON
treatment that would start immediately after delivery.
“We can also perform transfusions on the baby — through
the umbilical cord — while she or he is still in utero,” says Dr.
Rosen. Recalling a recent complex case that was referred to
MFM from another regional perinatal center, he says, “The
mother was so grateful that she named her baby after me and
the sonographer who assisted during the procedures.”
Dr. Rosen pauses, then adds: “Actually, I got the middle
name; the sonographer got the first name.”
High-Risk Deliveries Increase
the Need for Specialized Anesthesia
Specialized anesthesia plays a critical role in the outcome
of high-risk deliveries, says Shaul Cohen, MD,
professor of anesthesiology. The increase in diabetes and
obesity has led to a rise in high-risk deliveries, says Dr.
Cohen. In a severely overweight patient, it can be difficult
to safely secure the airway and to successfully bypass the
vocal cords. Dr. Cohen prefers to use a epidural-spinal split,
a combined approach that avoids the airway problem, may
enable a vaginal birth and produce a healthier baby, and
gets the patient back on her feet sooner. Controlling pain
can be especially important for women with cardiovascular
disease, he adds, because pain causes a rise in heart rate and
blood pressure.
With a “walking epidural,” a patient-controlled form of
pain management, a woman administers analgesics to herself
locally during the post-partum period, when and as she
needs it. The epidural eliminates weakness in the lower
extremities, says Dr. Cohen, so she can move about comfortably
on her own, and it lowers the risk of thrombosis
(blood clot formation) and pneumonia.
Ensuring a High and
Inclusive Standard of Care
P
regnant women who are HIV-positive receive specialized
treatment in the Robert Wood Johnson
AIDS Program (RWJAP), a division of the Department of
Pediatrics. During their pregnancy, they are seen by MFM
Robert Wood Johnson ■ MEDICINE 21