Revolutionizing Care Before Birth for Life-threatening Conditions

Published on in CHOP Annual Report

N. Scott Adzick, MD, MMM, is laser focused as he and the surgical team do what many once thought impossible: open a mother’s uterus, perform surgery on the fetus, then close the uterus, allowing the child to continue developing until birth.

Dr Adzick and Lori Howell

Hours before the sun rises, an alarm sounds and N. Scott Adzick, MD, MMM, awakens to begin another busy day as Surgeon-in-Chief at Children's Hospital of Philadelphia and Director of its Center for Fetal Diagnosis & Treatment.

By 7 a.m., he is at the Hospital prepping to perform an open fetal surgery for myelomeningocele (MMC), the most severe form of spina bifida, in which there is an opening in the back.

Adzick is a pioneer of fetal surgery,
in which lifesaving procedures are performed while an unborn baby is inside its mother's womb. He and the Center's multidisciplinary team co-led
 a groundbreaking study that proved
 fetal repair of MMC can produce better outcomes than traditional repair after birth, including improved chances of a child being able to walk independently.

At 8 a.m., surgery is in full swing. Adzick is laser focused as he and the surgical team do what many once thought impossible: open the mother's uterus, close the hole in the fetus' spine, then close the uterus, allowing the child to continue developing until birth.

The Center's team has performed more than 1,300 fetal surgeries to treat various birth defects, the most of any program in the world. The team also performs other, less-invasive procedures that offer improved outcomes, as well as nonsurgical therapies.

A dynamic duo

The surgery is over by 10 a.m. On his way to see his next patient, Adzick
 stops by the Garbose Family Special Delivery Unit, the first comprehensive birth facility housed in a pediatric hospital for women carrying babies with known birth defects, to check in on a patient on bed rest.

The SDU was the brainchild of Adzick and Lori Howell, DNP, MS, RN, the Center's executive director. It has revolutionized care by keeping mother, baby and family in one space for labor, birth and the postpartum experience. More than 2,350 deliveries have taken place in the unit to date.

Much of Adzick's and Howell's days are spent tackling the sundry tasks of running the largest and most comprehensive fetal diagnosis and treatment program in the world, which they've done together at CHOP since 1995. They lead the world's most experienced fetal team, which has cared for more than 18,000 expectant families, from all 50 states and more than 60 countries. Their office walls are peppered with pictures of patients reaching childhood milestones, living proof of the impact their work has had. The Center's very first patients are now in college, making plans for their futures.

One of the things I'm most proud of is the way we treat patients. We place them on a pedestal and provide them the best medical care in the world.— N. Scott Adzick, MD, MMM

"It's incredible to look back on the past 20 years," says Howell, who is known as the glue that connects the many working parts of this complex center. "We battled a lot of skepticism in the beginning, even from our own colleagues. It's remarkable to see how far we and our patients have come."

Always advancing

The Center continues to push the envelope, with advances in in utero stem cell transplantation and gene therapy, and efforts to develop an external support system designed to help preterm infants bridge the gap between their mother's womb and the world.

"Every accomplishment we've had, day after day, year after year, has inspired us to keep discovering, keep finding new and better treatments that will help even more children live the fullest lives possible," says Adzick.

Just after 5 p.m., he gathers around a table with other members of his team for consultation with a family who has traveled cross-country for a second opinion.

After a daylong evaluation, the team reviews the diagnosis and lays out a detailed plan of care, giving this family — like so many before them — what they've journeyed so far in search of: hope.


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