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A successful fetal center provides a complete continuum of care for complex fetal patients, expectant mothers, and families. Ongoing communication among community obstetricians, pediatricians, maternal-fetal medicine physicians, neonatologists, and other pediatric specialists is critical to provide comprehensive prenatal counseling and establish a supportive care team for families before and after the birth of their child. This case reveals the role of a fetal center in planning for the delivery and resuscitation of conjoined twins and their subsequent postnatal care.

First trimester screening for fetal aneuploidy is now the standard of care for pregnant women residing in the United States and other developed nations. Today screening includes both biochemical and ultrasonographic parameters; however, ongoing research and advances in ultrasound and cell-free fetal DNA make this a rapidly evolving and exciting field. For example, it is conceivable that noninvasive fetal genotyping in the first trimester may one day (not so distantly in the future) be incorporated into routine screening paradigms. This review aims to explore advances in first trimester screening and also discusses several potential future directions.

Advances in the diagnosis of congenital defects have led to the development of a multidisciplinary approach to prenatal counseling and postnatal management. New techniques in fetal imaging, including magnetic resonance imaging (MRI), provide clinicians with better anatomic detail of such anomalies. This added information facilitates frank prenatal discussions with families, anticipating challenges in delivery room resuscitation and planning of postnatal care. In this report, we review three cases of giant omphalocele (GO) at our institution, highlighting the changes in practice management for prenatal diagnosis and consultation. We discuss controversies regarding mode of delivery and describe the evolution toward an initial nonsurgical approach to GO.

Since the discovery of cell-free fetal DNA (cffDNA) in peripheral maternal blood a decade ago, advances have been made in the identification and clinical application of these segments. Most studies of cffDNA have focused on using the segments for sex determination and fetal Rh genotyping, employing differences in genomic DNA between mother and fetus. Research has shifted toward targeting cffDNA for noninvasive aneuploidy detection. Over the last decade, a tremendous volume of research has focused on advancing the understanding of cffDNA structure, function, and detection. Despite this growing body of evidence, gaps in understanding of the biology of cffDNA and challenges in its isolation, enrichment, and processing have limited clinical applications in noninvasive prenatal diagnosis.