Connections: Fetal surgeons expand in-utero interventions | Winter 2022

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From OHSU Doernbecher Children’s Hospital

Stephanie Dukhovny, M.D.

Stephanie Dukhovny, M.D., is the director of the Fetal Therapy Program and a maternal-fetal medicine specialist and geneticist. She specializes in pregnancies with fetal anomalies.

When an anatomical survey ultrasound uncovers a fetal anomaly, parents and even providers can feel overwhelmed. For the last decade, the multidisciplinary Fetal Therapy Program at OHSU Doernbecher Children’s Hospital has provided a responsive resource for early diagnosis, intervention and treatment planning for fetuses with congenital conditions.

Our program sees 300 to 500 new patients a year who have a wide range of fetal anomalies. We are excited to expand our capabilities to help patients by adding two fetal surgeons to our team. Andrew Chon, M.D., a maternal-fetal medicine specialist, and Raphael Sun, M.D., a pediatric surgeon, will add the insight of their respective disciplines to the program.

Full spectrum of care close to home

With two fetal surgeons on board this fall, OHSU will be one of five programs nationally to offer comprehensive care for mother, fetus and neonate in one location. We are excited to include this last area of expertise for a fully comprehensive program, so patients in our region in need of complex fetal surgeries will no longer have to travel to distant hospitals for care.

Dr. Andrew Chon

Andrew Chon, M.D., is an obstetrician, gynecologist and maternal fetal specialist. He has advanced training in fetal surgery.

Dr. Raphael Sun

Raphael Sun, M.D., is an expert in prenatal anomalies. Along with pediatric surgery, he also specializes in fetal surgery including in-utero interventions, such as twin-to-twin transfusion syndrome and prenatal neural tube defect repairs.

Expanding options in fetal surgical interventions

Though the Fetal Therapy team can effectively treat most fetal anomaly cases, the addition of Drs. Sun and Chon allows us to offer families in the region highly intricate surgical procedures for fetal diagnoses amenable to intervention.

Beginning in January 2022, we anticipate offering additional fetal procedures, beginning with twin-twin transfusion syndrome (operative fetoscopy, laser photocoagulation).

Over time, we anticipate adding procedures, such as:

  • Acardiac twins (radiofrequency ablation or fetoscopic laser cord occlusion)
  • Alloimmune thrombocytopenia (medical/needle)
  • Alloimmunization and fetal anemia (intrauterine transfusion)
  • Amniotic band syndrome (operative fetoscopy)
  • Bronchopulmonary sequestration (ultrasound-guided laser)
  • Cardiac abnormalities (ultrasound-guided stenting, direct fetal medical therapy)
  • Chorioangioma (operative fetoscopy, laser photocoagulation)
  • Congenital pulmonary airway malformation (shunt, sclerotherapy)
  • Congenital diaphragmatic hernia
  • Congenital high airway obstruction (operative fetoscopy, laser perforation)
  • Congenital neck masses (fetal intubation)
  • Iatrogenic preterm premature membrane rupture (amniopatch)
  • Lower urinary tract obstruction (shunt)
  • Pleural effusions (shunt)
  • Renal anhydramnios (amnioinfusions)
  • Selective intrauterine growth restriction type II (operative fetoscopy, laser photocoagulation)
  • Open spina bifida (fetoscopic repair either via complete percutaneous or laparotomy-assisted)
  • Twin anemia-polycythemia sequence (individualized case-by-case for operative fetoscopy, laser photocoagulation)
  • Vasa previa, type II (operative fetoscopy, laser photocoagulation)

When to refer

Any patient with pregnancy affected by a major fetal anomaly or an ultrasound abnormality of any kind.