Fetal treatments used to improve fetal outcome or maximize newborn life frequently include some amount of maternal, fetal, or neonatal risk. Therefore, a fetal treatment facility must have access to resources to carry out such therapies and address any maternal, fetal, or neonatal difficulties that may emerge, either as a result of the therapy itself or as a result of the underlying fetal or maternal disease. As a result, a fetal treatment center requires a specialized operational infrastructure and the required resources to allow for adequate clinical oversight and monitoring and to encourage interdisciplinary collaboration among the essential specialists. Therefore, three care levels were recommended for fetal treatment facilities to match the projected care complexity with suitable resources to produce an optimal outcome at the institutional and regional levels.
A level I fetal therapy center should be able to provide fetal interventions that may be associated with obstetric risks such as preterm birth or membrane rupture but are unlikely to necessitate maternal medical subspecialty or intensive care, with neonatal risks no greater than those associated with moderate prematurity. A level II facility should be able to offer maternal intensive care and handle extreme newborn preterm. A level III therapy center should provide fetal interventions (including open fetal surgery) and be able to manage any associated maternal complications and comorbidities, as well as access to neonatal and pediatric surgical intervention, including indicated surgery for neonates with congenital anomalies.
Reference:journals.lww.com/greenjournal/Fulltext/2022/06000/Care_Levels_for_Fetal_Therapy_Centers.9.aspx
