Departments

The Prenatal Genetic Diagnostic Program provides expert genetic screening, testing, and counseling for parents. Our tests and services includefirst-trimester screening, chorionic villus sampling (CVS), amniocentesis, fetal blood sampling (FBS), and many others. After diagnosis, we provide counseling and connect patients to appropriate support networks to help parents adjust to and prepare for their child's special needs. In addition to pioneering the development of CVS and FBS, Yale has the most experienced team for these procedures in New England. Between 11 and 12 weeks after a woman's last menstrual period, she can instantly learn the baby's risk for Down syndrome and other abnormalities with our safe, noninvasive first-trimester risk assessment. Our team of specially-certified physicians, sonographers, and genetic counselors will provide patients with accurate information as quickly as technology allows. The procedure is simple: Patients provide a blood sample at least one week before their scheduled appointment, then visit us between weeks 11 and 14 of their pregnancy. Our comprehensive prenatal testing and genetic counseling services include: First and second trimester screenings Targeted ultrasound (formerly known as Level II ultrasound). We are equipped to perform targeted vaginal ultrasounds at an early gestational age, and provide diagnostic information early in a woman's pregnancy. Antenatal testing services. These services include nonstress testing, biophysical profiles, fetal versions, and PG gel insertions to help ensure fetal well-being throughout pregnancy. Fetal echocardiography. The Yale Fetal Cardiovascular Center is the most experienced diagnostic and treatment program of its kind in New England and provides the full range of prenatal surgical care. Prenatal ultrasound testing is typically performed during the second trimester to diagnose cardiac conditions in an unborn baby. Chorionic villus sampling (CVS). This is usually performed between the 10th and 12th weeks of pregnancy and involves the removal of a small sample of the placenta from the uterus. Amniocentesis. This is usually performed during the 15thweek of pregnancy or later, the procedure removes a sample of amniotic fluid from the uterus for evaluation. Fetal blood sampling. Fetal bloodis collected directly from the umbilical cord orfetus to test for signs of anemia and otherblooddisorders. Fetal tissue biopsy. This is typically performed between the 17thand 20thweeks of pregnancy, for patients who carry an abnormal gene for a severe skin disease to find out whether or not their fetus is similarly affected. Fetal karyotyping. This involving the collection of chorionic villi, amniotic fluid, or fetalblood to obtain and analyze chromosomes for abnormalities. Biochemical testing Fluorescence in situ hybridization (FISH) analysis. This involves laboratory testing to detect chromosomal abnormalities and other genetic mutations in a patient

For our youngest patients, we provide expert care in the neonatal intensive care units (NICUs) at Yale New Haven Children’s Hospital, Bridgeport Hospital, Waterbury Hospital, and Lawrence and Memorial Hospital in New London. We offer advanced treatments, including ECMO (Extracorporeal Membrane Oxygenation), a machine that acts as an artificial heart and lungs for a patient, which is crucial for an infant’s life-threatening heart and/or lung problems. Yale is home to the world’s first NICU. Every year, approximately 6,000 babies are born at Yale New Haven Children’s Hospital, and more than 850 newborns are admitted to the NICU. The NICU has a capacity of 55 patients, making it the largest clinical unit in the Children's Hospital, and the largest NICU in the state. Through participation in the National Institutes of Health’s neonatal research network and other national multicenter trials, we offer patients access to the latest treatments available. Our board-certified specialists care for newborns with a variety of problems including: Respiratory disorders Complex cardiac issues Genetic and metabolic diseases Congenital malformations, including lung malformations requiring ECMO Hypoxic ischemic encephalopathy Retinopathy of prematurity Problems of nutrition and growth Necrotizing enterocolitis Neonatal infections Anemia, jaundice, and other blood disorders Neurologic problems

The Yale New Haven Children’s Hospital Neonatal Transport Program is dedicated to providing safe and timely transport to and from referring hospitals and our facility in order to improve patient outcomes in the newborn period. This service is provided 24 hours per day year-round. Our Neonatal transport team is composed of a specialized group of providers, including NICU nurses, respiratory therapists, advanced practice providers, and physicians who are all trained in neonatal medicine. High-risk infants are cared for using state-of-the-art equipment and a specially designed ambulance that allows us to provide all the support needed during transport including: Therapeutic hypothermia Non-invasive respiratory support Conventional mechanical ventilation High frequency ventilation Inhaled nitric oxide Our team is committed to (1) providing efficient and timely access to transport from outlying institutions using the hospital-based Y ACCESS system; (2) providing excellent multidisciplinary patient care; (3) providing access to level IV support to hospitals in our region; (4) facilitating inter-hospital collaboration and networking; and (5) improving family support. FOR PHYSICIANS ONLY : To arrange a transport, simply call Y ACCESS at 1-888-964-4233 or 1-888-YNHH-BED to be immediately connected with a Neonatal-Perinatal Medicine Attending.

The Reproductive Genetic Counseling Program at Yale is made up of board certified and licensed genetic counselors and physicians who specialize in prenatal and reproductive genetic risk assessment and the latest genetic testing technologies. Our team provides expert guidance for individuals and couples who are pregnant or planning to become pregnant. As part of the genetic counseling process, our genetic counselors may obtain pregnancy, medical, and family histories; review test results; identify and address issues of concern; describe available screening and diagnostic test options; advocate for their patients; provide short-term psycho-social support; collaborate with specialists; and assist individuals with making decisions that are best for themselves and their families. Common reasons for referral include: Personal or family history of a known or suspected genetic condition Personal or family history of a congenital disorder and/or intellectual disability Multi-fetal pregnancy (twins, triplets, quadruplets, etc.) Abnormal ultrasound findings Recurrent pregnancy loss Abnormal cell-free DNA or maternal serum screening results Interest in pursuing prenatal diagnostic testing (chorionic villus sampling [CVS] or amniocentesis) Some test options that may be discussed during a reproductive genetic counseling session include: Genetic carrier screening First trimester ultrasound with nuchal translucency assessment Second trimester fetal anatomy scan Screening tests Combined first trimester screening Second trimester maternal serum marker screening (i.e. quad screen) Cell-free DNA screening Diagnostic testing Chorionic villus sampling Amniocentesis F.I.S.H. analysis Standard chromosome analysis Microarray analysis/array comparative genomic hybridization Whole exome sequencing Preimplantation genetic testing (P.G.T.) For appointments, please call 203-495-2949

Treating complicated pregnancies is our priority. We provide care for the entire spectrum of conditions related to high-risk pregnancy, and for women whose pregnancies require special testing, monitoring, treatment, and care . We offer state-of-the-art approaches to caring for women with high-risk pregnancies related to diabetes, hypertension, heart disease, and genetic disorders, among other medical conditions that can complicate a pregnancy. Maternal-Fetal Medicine (MFM) at Yale pioneered the development of chorionic villus sampling (CVS) and fetal blood sampling (FBS), and has the most experienced team for these procedures in New England. In addition, our skilled specialists, who are internally recognized for their expertise, conduct fetal echocardiography to diagnose congenital heart disorders of the fetus. We offer a variety of services for our patients across the following specialty programs: High-Risk Pregnancy Program, which supports ongoing care and management for women with a history of pregnancy risks or current medical complications. Prenatal Genetic Diagnostic Program, which provides expert genetic screening and testing for MFM patients. Available tests include first-trimester screening, CVS, amniocentesis, and FBS. After diagnosis, we provide counseling and connect patients when necessary to appropriate support networks to help parents adjust to and prepare for their child's special needs. Recurrent Pregnancy Loss Program, offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Other services offered in our MFM section include: First-trimester risk assessment for Down Syndrome Targeted ultrasound Fetal therapy, including percutaneous umbilical blood sampling (PUBS) and intrauterine transfusion Antenatal testing Diabetes management MFM physicians can also co-manage patients with high-risk pregnancies with referring practitioners. We can develop care plans with community obstetricians for cases that require intensive oversight by the team, or consultative guidance alone.

For patients in our care during labor and delivery, we work in close collaboration with Yale’s Obstetrics, Gynecology, and Reproductive Sciences team. We also offer consultative services and management for high-risk obstetric patients. We provide different types of regional (local) anesthesia for vaginal and cesarean deliveries, tubal ligations, fetal surgeries, and EXIT procedures (for babies who have airway compression). We also have expertise in regional blockade for postoperative pain relief, and the use of ultrasound for regional analgesia and epidural placements. Along with our colleagues in maternal-fetal medicine, we provide anesthesia consultation for patients with complex medical issues such as congenital and acquired heart disease, neurological conditions, and clotting disorders. As a tertiary care center, Yale New Haven Hospital is equipped with facilities to care for patients with significant risk of peripartum hemorrhage, such as those with placenta accreta, which occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall.

We provide ongoing care and management for women with a history of pregnancy risks, or current medical complications. Our providers follow patients closely from the point of referral to delivery and beyond. Patients receive individualized attention, and continuity of care is guaranteed throughout the pregnancy. We are often able to co-manage problems with our patients’ primary obstetrician. However, our High-Risk Pregnancy Program provides the full spectrum of prenatal, delivery, and postpartum care for women with high-risk pregnancies. We offer the following specialty programs: Diabetes in Pregnancy Program. This provides comprehensive services for women with diabetes before, during, and after pregnancy. Our expert team of physicians, diabetic educators, and advanced practice nurses helps initiate and manage oral hypoglycemic and insulin therapies to ensure optimal glycemic control in pregnant patients with diabetes. Our team approach has resulted in significant decreases in our patients' A1C levels, rates of fetal macrosomia (high birth weight), and incidence of pregnancy complications. Hemostasis and Thrombosis Services. Our specialists provide pregnancy management for women who suffer from thrombosis, including regular consultations and treatment with blood thinners. In addition, we provide screening and primary care, as well as treatment for other blood conditions such as hemophilia. Recurrent Pregnancy Loss Program. This is offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Women & Children’s Blood Disorders Program. This program strives to improve the quality of women and children's health by addressing disorders of blood coagulation and thrombosis during the reproductive, menopausal, fetal, neonatal, and geriatric periods of life. The program also provides patient care and management for pregnant women with preeclampsia (high blood pressure, swelling, protein in the urine).

Providing patient-centered, compassionate gynecologic care is our priority. Our diverse team of gynecologists offers consultative and treatment services for a comprehensive range of gynecologic conditions. Our clinical expertise in prevention, screening, and diagnosis of gynecologic cancers, prevention and treatment of gynecologic infections, fibroid management, management of endometriosis and pelvic pain, contraceptive services, and gynecologic care for patients with HIV are just a few examples of areas in which we are proud to be making a difference in our community. We offer state-of-the-art approaches to individualize the care of women with complex gynecologic conditions, including those that are precancerous, require minimally invasive surgery, or other advanced medical or surgical treatments. We care for patients of all ages across the entire community, including those who are underserved. We offer expertise in treating a variety of conditions including: Abnormal pap smears Abnormal uterine bleeding Chronic pelvic pain Complex surgical histories Endometriosis Fibroids Menopausal symptoms Ovarian cysts Pelvic infections Precancerous changes in the vulva, vagina, cervix (dysplasia), or uterus (hyperplasia) Sexual dysfunction Additionally, we provide the following specialty services: Minimally Invasive Gynecologic Surgery (MIGS) . We offer an array of advanced laparoscopic, robotic, vaginal, and hysteroscopic surgical techniques to manage benign and precancerous gynecologic conditions. Office-based procedures. We offer several in-office procedures including colposcopy and LEEP, contraceptive implant and IUD insertion and removal, diagnostic hysteroscopy, endometrial and vulval biopsies, and trigger point injections in a safe, comfortable, and convenient setting. Transgender care. We offer surgical consultation for women transitioning to men. Pre-invasive gynecology care. We provide multidisciplinary evaluation and management of abnormal pap tests and precancerous conditions of the uterus, cervix, vagina, and vulva using the most up-to-date practice guidelines, in collaboration with gynecologic pathologists. Chronic Pelvic Pain. We provide a comprehensive, patient-centered approach to pelvic pain. We work with a multidisciplinary team (colorectal, urology, interventional radiology, social work, physical therapy, and vascular surgery) to address pelvic pain, which often has multiple causes. We are committed to working closely with local practices, community-based health centers, and colleagues in other medical specialties to ensure coordination of timely and appropriate gynecologic care for our patients. Our multidisciplinary approach includes partnership with primary care, other surgical specialties, pathology, radiology, social work and care coordination. We are committed to serving the community and providing access to care. Our collaborative care model includes working with the Connecticut Veterans Administration Health Care System, Corn

Our program, focused on adult primary care, is known for its excellence and emphasis on prevention and wellness. We efficiently manage potential medical problems as they arise, and collaborate with specialists when needed. Our practice includes internal medicine physicians, advanced nurse practitioners, a clinical psychologist, a social worker, registered-nurse patient care coordinators, licensed practical nurses, medical assistants, clerical office staff, and a practice supervisor. Our goal is to provide patients with the highest quality, personalized healthcare in the Patient-Centered Medical Home (PCMH) model of care. The PCMH model of care focuses on five areas: Building strong, collaborative health care teams that work together to meet the needs of patients Providing patient-centered care addressing the whole person, respecting patients’ values and preferences Coordinating comprehensive health care through clear communication among patients, families, caregivers, medical and behavioral health providers, hospitals, and other facilities Improving patients’ access to care, through such initiatives as expanded office hours and providing email access to electronic medical records Improving health care quality and standards by providing evidence-based care, patient and family education, and self-management support We would like to hear your direct feedback regarding your experience as a patient/family member of our clinic. Please visit the YIMA Patient/Family Comment Box to provide your feedback. Sign up for MyChart , our secure online patient portal, that gives you access to all of your Yale health information whenever you need it, wherever you may be.

The Yale Family Planning program’s vision is to provide reproductive health care rooted in dignity, equity, and science. Our mission is to provide exceptional care through evidence-based medicine, essential education, rigorous research, and advocacy focused on abortion and contraception. We provide compassionate and evidence-based care for people when they need birth control, as well as when they face unexpected or unhealthy pregnancies and need abortion care or miscarriage treatment. We support our patients’ journeys with respect. We know that all people deserve comprehensive information about their treatment options to make the best decision for themselves and their families. When it comes to reproductive health, we put our patients’ needs above all else. Our team includes subspecialty-trained physicians and dedicated nurses who provide compassionate care for our patients and their families. When our patients’ medical needs are complex, we partner with an interdisciplinary team of high-risk obstetricians, anesthesiologists, and medical specialists. Our services include: Pregnancy prevention with contraception: Contraceptive counseling and care Specialty contraceptive care for women with complex medical conditions (bleeding or clotting disorders, kidney failure, prior heart attack, organ transplant, or weight-loss surgery) Expertise with intrauterine devices and arm implants Pregnancy loss care: All options for management of early miscarriage Surgical management of second trimester pregnancy loss Bereavement support for pregnancy loss Abortion care: Medical abortion care in the first trimester Surgical abortion care through 23+6/7 weeks gestation Option of general anesthesia (to be “asleep“) for the procedure Bereavement support for ending a pregnancy Preoperative visit. This visit will include counseling, a medical history review, an exam (possible ultrasound and pelvic exam) and possible blood testing. The doctor will also review preoperative instructions (including arrival time for procedures), and consent forms will need to be signed. Patients should plan 1 to 1.5 hours for this visit. A support person is welcome. Before a preoperative visit, patients may need to have a separate ultrasound visit. Operative visit. Generally, the operative procedure will be the next day. Patients must not eat or drink for at least 8 hours before the procedure time, usually not after midnight the night before. Since patients will be affected by the anesthesia for the rest of the day after the procedure, they must have a ride home with someone who is at least 18 years old. They should plan to spend 5 to 6 hours at the hospital this day. Contraceptive visit. At this visit, we will review the patients’ medical history, counsel them on options for contraception, help them select a method that is right for them, and start that method. To prevent a concern for possible pregnancy at this visit, patients should not have unprotected sex for 15 days b

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi

We specialize in the care of women throughout pregnancy, childbirth, and their reproductive years. We offer holistic, family-centered, physiologic, and natural approaches to childbirth combined with evidence-based and appropriate medical care. Our mission is to support and empower all women and families to become active participants in decisions about their health, while providing safe, comprehensive care. At Yale, there is a special relationship between obstetricians and midwives. Because of the long history of midwifery in the Yale community, certified nurse-midwifery is embraced and considered an integral part of the care we provide. A certified nurse-midwife is a highly trained practitioner with a master of science degree in nursing, with further training and certification through an accredited nurse-midwifery program. Nurse-midwives specialize in the care of women in a holistic manner and recognize when additional support and consultation are necessary. An obstetrician is a physician who has earned a medical degree followed by a four-year residency in obstetrics and gynecology, focusing on the female reproductive system, including diseases and disorders that may require medical or surgical management. Obstetricians specialize in the management of pregnancy complications, labor, childbirth, and the postpartum period. The nursing staff and providers support individualized care for women based on their unique needs and preferences, supporting natural childbirth with water immersion and aromatherapy, while also providing easy access to modalities such as narcotic and epidural analgesia, as desired.