Brown Medical School among first in U.S. to start fetal medicine program.

By Sophia Khan

The Brown Daily Herald, Wednesday, October 25, 2000.

When considering fetal medicine, there exists what Dr. Francois Luks calls a "very gray zone" - the fine line between a fetus and a premature baby, and the distinction between a pregnant woman and the fetus in her belly.
According to Luks, an associate professor of surgery and a pediatric surgeon, doctors have only recently "started to consider the fetus as an actual patient."
Since ultrasounds came into regular practice about 50 years ago, fetal medicine has traditionally been taught by obstetricians. Now it is evolving into a separate discipline, encompassing the expertise of many different fields.
Brown's new Program in Fetal Medicine involves medical students by bringing the previously post-graduate, multidisciplinary approach to fetal medicine to the level of medical education. Luks directs the program, which is organized by Dr. Thomas Tracy, associate professor of surgery, and Dr. Stephen Carr, associate professor of obstetrics and gynecology.
The program draws from the Department of Obstetrics and Gynecology, the Department of Surgery, and the Department of Pediatrics. The program professors treat patients, teach classes, and conduct research - all part of the program's aim to integrate medical education, research, and clinical work.
The idea for the fetal medicine program was conceived in 1999 by a group of fetal medicine specialists with various backgrounds, according to Carr.
Although still an abstract entity, Luks said he hopes the program will help consolidate the teaching of fetal medicine within two years.
The most exciting part of the program, Luks said, is that it makes Brown "one of the first universities to look at fetal medicine from an independent standpoint."
The new program is not the first initiative of its kind that has been put forth by Brown faculty. In 1997, a group of medical professors began the Multidisciplinary Antenatal Diagnosis and Management Initiative (MADAM), which convenes twice monthly and attracts crowds of 30 to 50 people from different specialties to discuss both specific cases and more general topics.
Doctors with different areas of expertise have been working together for several years now, but last year several faculty members decided to organize what has been for years a de facto division of fetal medicine, Luks said.
They applied to the dean of the School of Medicine, and continued through several committees in an attempt to become what Carr termed a "Brown University-sanctioned collaboration of expertise."
Carr, who is a specialist in maternal fetal medicine, said he is very excited about the recognition his group has received from the University.
Carr and Luks said the fetal medicine program involves not only education and service, but also incorporates research. The program led to the development of a new surgical procedure this past summer. Fetuses have been operated on for 15 years, but the operations have taken place sporadically and in very few places.
Over the summer, a group of about 10 to 15 people gathered in a surgical room to operate on twin fetuses that suffered from twin-to-twin transfusion syndrome. In order to prevent blood from flowing from one twin to the other - and to protect the lives of both twins - the surgeons closed all the blood vessels that connected the twins.
Advances in technology and knowledge are making previously untested procedures such as this one possible.
Carr said that when considering in-utero work, doctors must know the progression of a potential disease and the harm it might incur, must be able to change potential outcomes, and must be confident about the level of risk of the procedure.
Above all, he said that the success of the procedures depends on the parents who entrust their own well-being and the well-being of their children to the doctors.
In order to gain approval for a new procedure, doctors must apply to a hospital's Institutional Review Board, which determines the scientific soundness of the procedure. But even more important, Luks said that they first run the procedures by MADAM, which is more in tune with recent, worldwide information.
Plans are currently underway for a regional fetal medicine conference at Brown in the spring of 2001. The conference, which will showcase various different nationally renowned specialists, will be geared in part toward medical students.