Responsible for the care of both mother and baby during complex, high risk pregnancies, maternal fetal specialists are tasked with some of the medical field’s most delicate circumstances.

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Between managing congenital disorders and fetal abnormalities, and even aiding in the management of maternal or fetal cancer in pregnancy, these physicians must discover the right balance of treatment as they protect two lives at once. At Hackensack Meridian Health, there are several different divisions of maternal fetal services, all working closely together to safeguard the health of both mother and child.

“Hackensack Meridian is very unique when it comes to the management of high risk pregnancies,” noted Dr. Jesus Alvarez Perez, a maternal fetal medical physician and director of obstetrics for the Hackensack University Medical Center. “We employ a multidisciplinary team of specialists who meet regularly to discuss the care of each patient and their unborn infant. We also collaborate with the patient’s private obstetrician to deliver the best treatment.”

Dr. Alvarez Perez described his staff’s daily tasks, starting with managing post op complications, which include postpartum hemorrhage or any other obstetrical critical care conditions. The subspecialty also takes care of invasive fetal procedures like intrauterine blood transfusions or intrauterine fetal stents as well as maternal obstetrical complications like abnormal placentation which is considered one of the main causes of maternal mortality worldwide.

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“Hackensack University Medical Center pioneered the development of a Center for Abnormal Placentation, which I joined in 2013,” noted Dr. Alvarez Perez, who was recruited to help build the center.

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Abnormal placentation, better known as placenta accreta, occurs in between one in 276 and one in 500 births. It refers to a condition in which the placenta grows deeply into the wall of the uterus. During placenta accreta, the placenta fails to separate during delivery, which can cause severe hemorrhaging. With experience that comes from handling more than 20 such cases a year, its pre delivery diagnosis has been improved at Hackensack University Medical Center, and delivery complications have been significantly reduced. Two senior research scientists are actively working on data collection and outcome analysis for the condition, and the hospital’s program has received national attention for its work.

“We are doing a lot of work to discover why this happens,” Dr. Alvarez Perez noted. “Why does the placenta become invasive, why do some mothers have more of a propensity to develop this disease, and what techniques can we apply to fix it?”

He also works closely with patients who are diagnosed with cancer during pregnancy, monitoring the effects of chemotherapy on the fetus. He recently collaborated on the care of a patient with Dr. Merieme Klobocista, a gynecologist/oncologist at Hackensack Meridian Health, Hackensack University Medical Center, and the Mountainside Medical Group.

“At the age of 30, she was diagnosed with cervical dysplasia at 13 weeks pregnant,” Dr. Klobocista noted. “A cone biopsy was performed shortly thereafter, as well as a cerclage procedure. The baby was carried full term, and the mother is happily carrying her second child now. She goes for her yearly screenings, which have been clean ever since.”

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Dr. Klobocista, who was recruited by Hackensack Meridian Health four years ago to expand the gynecological oncology program at the Mountainside Medical Center’s Cancer Program, said that cervical cancer has become a common occurrence in young women.

“We do see a fair amount of it,” she said. “And while endometrial cancer is the most common gynecological cancer that affects women, we also see instances of ovarian and vulva cancers. There are a broad range of issues here that need prompt attention.”

“We recently had a pregnant patient present with a complex pelvic mass,” Dr. Klobocista said. “We were able to remove it and thankfully it was benign, but it took solid collaboration among doctors in different divisions to diagnose and treat.”

According to Dr. Klobocista, that collaboration is paramount to the success of Hackensack Meridian Health’s Maternal Fetal Medicine Services.

“The Comprehensive Cancer Center works closely with other divisions in oncology as well as other divisions in the hospital, such as high risk maternal fetal medicine, to provide the best outcomes,” Dr. Klobocista noted. “We have a thriving fertility division where young women afficted with cancer can preserve their eggs before undergoing treatment, and the network is a participant in many clinical trials, which allows us to offer patients cutting edge medicines to treat their illness.” Dr. Alvarez Perez echoed those sentiments.

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“Hackensack Meridian Health has been a leader in the field of maternal fetal medicine,” he concluded. “We have one of the lowest maternal mortality rates in the country and one of the lowest rates of post-operative blood transfusions after an accrete surgery. Our highly trained staff of physicians is well equipped to handle every type of case, from multiple gestations to management of complicated cardiovascular or diabetic disorders in pregnancy to placement of an abdominal cerclage or surgery for a pregnancy with an accreta. Together, we will formulate the best plan of action for both mother and child. To have this type of care right here in New Jersey is vital.”

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