The Level III Neonatal Intensive Care Unit (NICU) is housed at the General Campus. Within the region of Eastern Ontario and Western Quebec, women at risk of preterm birth (twins and higher order multiples less than 32 weeks and singletons less than 30 weeks) are transferred to the General Campus for care. Premature twins born under 32 weeks gestation are admitted to the Level III NICU at the General Campus. Other premature newborns between 30 and 36 weeks may also be cared for in this unit or at the Level II NICU at the CIVIC site. Babies with anatomic structural problems such as heart defects or other anomalies are born at the General Campus but will be transferred to the Children’s Hospital of Eastern Ontario (CHEO) for pediatric surgery. The Neonatology service provides antenatal counselling for mothers at risk of preterm delivery (such as twins or triplets) or other fetal problems that may require admission to the NICU.

Geneticists and genetic counsellors at CHEO play an important role in daily care of patients with high-risk pregnancies. They provided in depth counselling regarding risks of genetic diseases, the risks and benefits of non-invasive and invasive genetic screening and diagnosis, and up-to-date information on the availability of highly specialized prenatal testing for rare genetic disorders.

Specialists in fetal diagnosis of congenital heart diseases work closely with us to provide prenatal diagnosis of fetal cardiac defects. Initial screening by fetal ultrasound takes place at both campuses of TOH and detailed fetal heart examination with formal fetal echocardiography is done at both the General Campus and CHEO with the pediatric cardiologist in attendance.

Pediatric radiologists at CHEO provide fetal MRI services for our patients for enhanced imaging of certain fetal anomalies, in particular, structural differences involving the fetal central nervous system.

In conjunction with medical internists, the unit provides concurrent care of patients with medical problems of pregnancy such as hypertension, diabetes, thyroid disease and clotting disorders.

Obstetrical Anaesthesia at TOH includes a group of physicians who provide a wide range of anesthetic and analgesic options for care during delivery. These include pre-operative consultation, complicated IV access, invasive blood pressure monitoring, patient-controlled analgesia, regional anesthesia (epidural and spinal) as well as general anesthesia. An anesthetist is present in the delivery room for all twin and multiples deliveries.

A team of perinatal pathologists at CHEO provides diagnostic pathology services to obstetric patients for the Eastern Ontario region. Microscopic examination of unusual or abnormal placenta is provided for patients experiencing perinatal complications and detailed examination of the fetus is performed at the parent’s request in cases of fetal loss. Results of these examinations help the MFM team gauge the risk to future pregnancy and plan therapeutic interventions to reduce future risk.

A team of psychiatrists and psychologists provide consultation services for MFM patients experiencing mental health difficulties throughout pregnancy and in the immediate post-partum period. These professionals are highly experienced in the management of psychiatric medications during pregnancy to minimize fetal risk. They work with community-based mental-health care providers to optimize the care of MFM patients following delivery.

The MFM team includes two nursing professionals who coordinate the care of our high-risk patients. They receive all patient referrals by fax and prepare all supporting documents for review and triage. Coordination of care includes patient advocacy, booking consultation visits, multidisciplinary referrals and appointments, arranging fetal therapeutic procedures and daily communication with physicians about ongoing patient issues during pregnancy. The nursing team provides supportive counselling to patients with special needs, such as those with structural differences or requiring fetal interventions like intrauterine transfusion.