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CENTER FOR ADVANCED OBSTETRICAL CARE & RESEARCH (CAOCR)

ABOUT THE PROGRAM

The Center for Advanced Obstetrical Care and Research (CAOCR) was created in 2008 for the single purpose of providing the most advanced obstetrical care available anywhere to mothers and their unborn babies. The Center achieves its purpose by providing excellent and compassionate patient care combined with world class research and the education of tomorrow’s care givers.

While Wayne State University (WSU) and the Detroit Medical Center (DMC) are primary affiliates, the Center is an integral part of, and receives its major funding from, the Perinatal Research Branch (PRB) of The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services.

The Center serves the needs of expectant mothers with normal pregnancies as well as mothers with pregnancies complicated by conditions such as premature labor, premature cervical shortening, diabetes, as well as hypertensive disorders like chronic hypertension and pre-eclampsia. Direct patient care in the Center is provided by a team including physicians who specialize in Maternal-Fetal Medicine and Fetal Ultrasonography, Certified Nurse Midwifes, Registered Nurses, Ultrasound Technicians, in addition to Medical and Administrative Assistants. The Center has developed a worldwide network of colleagues and collaborators which enhances the ability of the Center’s care team to ensure excellent care for even the rarest disorders.

The pregnant women who receive their care in the Center have volunteered to participate in various research studies sponsored by the PRB. They understand that although these studies may not directly benefit them, or their children, during their current pregnancies, they realize research is the key to eventually solving the problems that jeopardize pregnancies everywhere. All studies conducted by the Center are rigorously reviewed by government and university mandated committees that are not part of the PRB. The members of these committees ensure both the safety and ethical soundness of all research proposals before they are initiated by the Center.

Additional Services Offered by the CAOCR:

  • A fetal ultrasonography team led by an internationally recognized expert using some of the most advanced ultrasound equipment in the world
  • Genetic counseling, screening and diagnostic procedures (e.g. chorionic villus sampling, CVS or amniocentesis for both maternal and fetal conditions)
  • Access to fetal interventions including intrauterine transfusions and fetal shunt placements

Conditions Managed by the CAOCR’s Care Team:

  • Patients with a history of premature labor and/or premature birth
  • Cervical insufficiency
  • Maternal medical conditions including, but not limited to:
    • Diabetes
    • Kidney disease
    • Cardiac disease
    • Thyroid disorders
    • Lupus
    • Rheumatoid arthritis
    • Asthma
    • Sickle cell and Beta thalassemia diseases
    • Rh disease
    • Hypertension
    • Preeclampsia
    • Cholelithiasis of pregnancy
  • Fetal anomalies like cardiac and brain defects
  • Twins and higher order multiple gestations
  • We provide counseling, prenatal care, referrals, and testing for patients with a personal or family history of genetic disorders

Social and Environmental Aspects of Care Facilitated by the CAOCR:

  • We partner with Wayne State University’s Make Your Date, an organization using evidence-based strategies to reduce the rate of premature birth
  • Referrals for mental and behavioral health issues
  • Birthing classes
  • Breastfeeding instruction
  • Diabetic education and Dietician counseling

INFORMATION FOR PATIENTS

If you are pregnant, or planning to become pregnant, and would like to receive your prenatal care along with a chance to participate in the Center’s research mission while receiving some of the highest quality prenatal care available anywhere, use the following contact information:

The Center for Advanced Obstetrical Care and Research (CAOCR)
Hutzel Women’s Hospital
4 Webber North (4th Floor)
3990 John R
Detroit, Michigan, 48201

Or call (313) 577-8832 (preferred) to make an appointment with us. Transportation services are typically available for all appointments if needed.

OBJECTIVES

  • To discover and study biomarkers for the prediction of the great obstetrical syndromes (e.g. preeclampsia, fetal growth restriction), including personalized assessment
  • To execute longitudinal research protocols and studies of the PRB in normal and high-risk pregnancies through data collection, biological specimen retrieval, sonographic examination of the mother and fetus, etc.

RESEARCH HIGHLIGHTS

Pioneering work and scientific accomplishments of the PRB have changed the practice of medicine and improved knowledge about the pathophysiology of the great obstetrical syndromes. For example, the use of vaginal progesterone to prevent preterm birth in women with a sonographic short cervix has become a standard of care, and has the potential to save the U.S. $500 – 750 million annually in avoided healthcare costs.

Select scientific accomplishments related to research conducted at the CAOCR include:

  • Developed a customized approach to cervical length assessment which improves the prediction of spontaneous preterm birth
  • Discovered that a low maternal angiogenic index-1 at 24-28 weeks of gestation identifies subsequent fetal death
  • Developed a “proteomic clock” of normal pregnancy, comprised of proteins that change with gestational age (this will serve as the foundation for discovery of proteomic
  • biomarkers of adverse pregnancy outcomes)
  • Created a new customized fetal growth standard for African American women
  • Discovered the first biomarker for placental vascular disease, which is predictive as early as the mid-trimester of pregnancy
  • Demonstrated that sonographic elastography of the uterine cervix can be used for risk assessment of preterm birth in the mid-trimester
  • Developed Fetal Intelligent Navigation Echocardiography (FINE), a novel sonographic advance that allows the automatic display of nine standard fetal cardiac views required to
  • diagnose most cardiac defects; this technology is now available on several commercially available ultrasound systems (known as 5D Heart)
  • Developed Color Doppler FINE, a technologic advance that provides clinically useful information about fetal cardiac structure / function in normal and abnormal fetal hearts; this
  • technology has been successfully integrated into commercially available ultrasound systems (known as 5D Heart Color)
  • Developed a novel sonographic approach to evaluate fetal growth, known as Individualized Growth Assessment (IGA)
  • Reported a detailed longitudinal characterization of the cellular transcriptome in the maternal circulation during normal pregnancy
  • Proposed that an imbalance in angiogenic / anti-angiogenic factors is predictive of massive perivillous fibrin deposition, which results in recurrent fetal death and growth restriction
  • Identification of biomarkers for the prediction of preeclampsia and delivery of small for gestational age neonates
  • Identification of amniotic fluid sludge as a predictor of preterm birth
  • Proposed a mid-trimester sonographic short cervix as a biomarker for prediction of spontaneous preterm birth, and demonstrated that vaginal progesterone reduces the rate of preterm birth by 45%
  • Determined a sonographic short cervix as the only clinical manifestation of intra-amniotic infection

SELECT PUBLICATIONS

  • Personalized assessment of cervical length improves prediction of spontaneous preterm birth: a standard and a percentile calculator. Gudicha DW, Romero R, Kabiri D, Hernandez-Andrade E, Pacora P, Erez O, Kusanovic JP, Jung E, Paredes C, Berry SM, Yeo L, Hassan SS, Hsu CD, Tarca AL. Am J Obstet Gynecol 2020 Sept 9; online ahead of print.
  • Maternal whole blood mRNA signatures identify women at risk of early preeclampsia: a longitudinal study. Tarca AL, Romero R, Erez O, Gudicha DW, Than NG, Benshalom-Tirosh N, Pacora P, Hsu CD, Chaiworapongsa T, Hassan SS, Gomez-Lopez N. J Materna Fetal Neonatal Med 2020 Jan; online ahead of print.
  • The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski S. Am J Obstet Gynecol 2017;217:682.e1-e13.
  • Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Hassan SS, Romero R, Vidyadhari D, et al. PREGNANT Trial. Ultrasound Obstet Gynecol 2011; 38:18-31.
  • Clinical significance of early (<20 weeks) vs. late (20-24 weeks) detection of sonographic short cervix in asymptomatic women in the mid-trimester. Vaisbuch E, Romero R, Erez O, Kusanovic JP, Mazaki-Tovi S, Gotsch F, Romero V, Ward C, Chaiworapongsa T, Mittal P, Sorokin Y, Hassan SS. Ultrasound Obstet Gynecol 2010; 36:471-481.

FACULTY

CHAUR-DONG (CD) HSU, M.D., MPH, FACOG is the Frank P. Iacobell Professor and Chair of the Department of Obstetrics and Gynecology and Professor, Department of Physiology at Wayne State University School of Medicine; Director of the Center for Advanced Obstetrical Care and Research; Director of the Perinatal Research Initiative and Project Site Manager of the Perinatology Research Branch, NICHD/NIH/DHHS, at Wayne State University; Chief of Gynecologic Oncology at Barbara Ann Karmanos Cancer Institute, and Specialist-in-Chief, OB/GYN at the Detroit Medical Center. Dr. Hsu completed his Obstetrics and Gynecology residency training at Beth Israel Medical Center in New York. He subsequently completed a postdoctoral research fellowship and a clinical fellowship in Maternal-Fetal Medicine, at the Johns Hopkins University School of Medicine.
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LAMI YEO, M.D., FACOG, FAIUM is Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University School of Medicine. She is also the Director of Fetal Cardiology at the Perinatology Research Branch, NICHD/NIH/DHHS; and Director of the Detroit Medical Center/Wayne State University/PRB Maternal-Fetal Medicine Fellowship Program. Dr. Yeo completed her Obstetrics and Gynecology Residency at Northeastern Ohio Universities College of Medicine, Ohio; and Maternal-Fetal Medicine Fellowship at University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School/St. Peter’s University Hospital, New Jersey. Her main research interests are the prenatal diagnosis of congenital anomalies and congenital heart disease through the use of conventional and volumetric (three- and four-dimensional) sonography.
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STANLEY M. BERRY, M.D. is Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University School of Medicine and the Perinatology Research Branch, NICHD/NIH/DHHS. He is the Research Project and Educational Mentor of the Maternal-Fetal Medicine Fellowship Training Program, Detroit Medical Center/Wayne State University/PRB. His training includes a Medical Doctorate from Mayo Medical School, Rochester, Minnesota; Obstetrics and Gynecology Residency at Saint Louis University, St. Louis, Missouri; MFM Fellowship at Wayne State University/Hutzel Hospital; and an 8-month research sabbatical at The Harris Birthright Centre, King’s College Hospital, London, UK. Dr. Berry’s primary area of interest is high-risk obstetrics. He was recently recognized as a “Coronavirus Hero” by Time Magazine.
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JEFFREY R. JOHNSON, M.D. is Associate Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University School of Medicine and the Perinatology Research Branch, NICHD/NIH/DHHS. His Training includes a Medical Doctorate from Boston University School of Medicine; Obstetrics and Gynecology Residency at Boston Medical Center; and MFM Fellowship at Ohio State University. He is an accomplished fetal therapist, and his research interests include hypertension, pre-eclampsia, and autoimmune diseases in pregnancy.
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CERTIFIED NURSE-MIDWIVES

Elberta Dziobak, C.N.M. is board-certified by the American Midwifery Certification Board (AMCB). She completed her Bachelor of Science in Nursing at Madonna University and her Master of Science in Nursing at Wayne State University. Elberta spent 11 years as a Neuro ICU nurse at Detroit Receiving Hospital and in 2016 transferred to the Labor and Delivery Unit at Sinai Grace Hospital. Elberta is committed to women’s health and well-being through her clinical specialty in midwifery.

Allison Grekin, C.N.M. began her career as a doula in Ann Arbor in 2010, earned her Bachelor of Science in Nursing from the University of Michigan in 2013, and graduated from the Wayne State University School of Nursing with a Master of Science in Nursing and a Nurse-Midwife clinical specialty in 2018. She has since worked as a Labor and Delivery nurse and taught nursing at Washtenaw Community College and Oakland Community College. Her professional interests center on patient education and women’s health across the lifespan.

Lisa Fields, C.N.M. holds a Doctorate of Nursing Practice (DNP) degree from the University of Michigan at Ann Arbor. She has worked for the Detroit Medical Center at Hutzel Women’s Hospital in the Labor and Delivery Unit as a nurse for three years and in its Neonatal Intensive Care Unit and Special Care Nursery for more than seven years. Devoted to the clinical specialty of midwifery, she focuses on the empowerment and support of women during the different stages of their lives, especially during pregnancy, labor, and birth.