REFER A PATIENT FETAL Rochester, Minnesota AT MAYO CLINIC Fetal Nurse Coordinator 507-422-6703 8 a.m.-5 p.m Central time Monday through Friday

For other specialty referrals: 800-533-1564

Use our referring provider portal to submit referral requests and view your patients’ Mayo Clinic medical records at the same time we do.

In addition, access to resources including clinical trials, CME, Grand Rounds, and scientific articles and videos are available.

mayoclinic.org/medical-professionals

MC1973-112 WHY CHOOSE MAYO CLINIC FETAL SURGERY EXPERTISE `` Mayo Clinic tailors treatments using advanced technology and techniques, Known for innovation and quality, patients many of which may not be available outside of Mayo, including new cutting- referred will experience Mayo Clinic’s edge, in utero therapies distinct approach to care and cutting-edge advancements in fetal surgery. `` Mayo Clinic surgeons include internationally-renowned, highly-specialized experts with extensive experience in fetal surgery `` Initiated new FDA approvals for fetoscopic surgery for and `` Mayo provides comprehensive care for pregnant women with complex improved the care of patients with maternal and fetal conditions spina bifida `` Mayo Clinic offers teleneonatology, a live audio-video telemedicine `` Led the way in new FDA approvals connection, for patients who deliver with their referring physician in a for fetoscopic regenerative therapy for congenital diaphragmatic hernia and hometown, community hospital improved the care of patients with congenital diaphragmatic hernia `` Mayo Clinic offers maternal and fetal medicine telemedicine, a live audio- `` Initiated new FDA approvals for fetoscopic surgery for bladder outlet video telemedicine connection, for patients with complex maternal and fetal obstruction (or lower urinary tract obstruction) and improved the care of conditions patients with lower urinary tract obstruction `` Mayo Clinic uses state-of-the-art imaging techniques, including 7-Tesla and `` Pioneered new FDA approvals for in utero interventions for severe renal MRI scanner, to accurately diagnose birth defects prenatally disease and bilateral renal agenesis `` Mayo Clinic’s outpatient setting allows for access to the fetal surgery multidisciplinary team including Mayo Children’s Center NICU Follow-up Clinic and the spina bifida clinic QUALITY AND CLINICAL OUTCOMES `` Mayo Clinic coordinates with the patient’s referring physician to provide Fetal surgery has been performed at Mayo Clinic more than 80 times during the last education and a follow-up care plan after all treatment is completed three years, including fetoscopic laser ablation of placental anastomoses for twin-to- twin transfusions and complicated monochorionic twins, fetal endoscopic tracheal `` Mayo Clinic offers a dedicated multidisciplinary team of experts in different occlusion for severe congenital diaphragmatic hernia, in utero repair, both open aspects of fetal and maternal conditions and fetoscopic, of fetal spina bifida, fetal for bladder outlet obstruction, fetal tumors and in utero intervention for severe congenital heart defects. The practice continues to grow in volume, lending itself to superior quality and improved MAYO’S FETAL SURGERY CARE TEAM outcomes for the patient and unborn child. Mayo’s fetal surgery integrated care team includes experts in maternal and fetal medicine, fetal surgery, , neurology, , , `` Mayo’s fetal surgery practice, in many cases, produces significantly better genetics, radiology and anesthesiology, as well as pediatric otolaryngology, outcomes and chances of survival than traditional postnatal repair pediatric nephrology, pediatric urology, pediatric neurosurgery, clinical nurse therapy and social services, as needed. `` Dual survival rate after fetoscopic laser ablation of placental anastomoses for twin-to-twin transfusion syndrome is higher than 80 percent `` Survival rate after fetal endoscopic tracheal occlusion for severe congenital diaphragmatic hernia higher than 80 percent `` Reversion of Chiari malformation after in utero repair of spina bifida is higher than 90 percent `` Mayo performs complex procedures using smaller instruments and scopes, achieving the same outcomes for the unborn child but with fewer maternal risks, such as the use of scopes for spina bifida repair allowing the patient to have a `` Mayo Clinic Children’s Center in Rochester, Minnesota is a top choice for referring providers in the U.S. for pediatric care Bringing together a multispecialty team of world-renowned fetal medicine and CUTTING-EDGE TESTS pediatric experts and researchers, Mayo’s Clinic’s fetal surgery practice is one of Patients referred to Mayo Clinic have access to unique tests and resources, the largest, most comprehensive prenatal diagnosis and treatment practices in including: the world. Housed in the Mayo Clinic Children’s Center and Mayo Clinic Maternal- `` 3D fetal ultrasound for detection of facial abnormalities or neural tube defects Fetal Medicine Center in Rochester, Minnesota, Mayo’s fetal surgery practice uses advanced technology and state-of-the-art facilities to offer a wide variety of `` Fetal therapy, including intrauterine blood transfusion, laser ablation of twin-to- cutting-edge, minimally-invasive techniques for fetal distress and abnormalities. twin transfusion and radiofrequency ablation Each year, Mayo’s fetal surgery practice performs many fetal surgeries to improve `` Fetal ultrasound and other sophisticated imaging technologies outcomes of the unborn child. `` First trimester Down syndrome screening Mayo’s fetal surgery practice offers medical professionals the opportunity to `` First trimester ultrasound screening for congenital anomalies refer and follow patients throughout their care. The practice understands the `` Genetic and chronic villus sampling importance of the relationship you have already defined with your patient and their family and makes certain to work closely with you to provide individualized, `` Testing related to increased maternal or paternal age leading-edge treatments and interventions to ensure the best care for your patient `` Testing related to increased risks of genetic conditions and unborn child. `` Noninvasive

CUTTING-EDGE PROCEDURES `` Percutaneous umbilical blood sampling, vesicocentesis and cardocentesis With access to state-of-the-art technology and subspecialty expertise, Mayo’s `` Targeted imaging for babies at risk of birth defects and fetal anomalies fetal surgery practice is uniquely positioned to provide a multidisciplinary `` Fetal MRI approach to both less invasive and open procedures performed in utero. `` Fetal echocardiogram `` Less invasive fetal surgery - Fetoscopic laser ablation of placental anastomoses for twin-to-twin transfusion syndrome, TAPS, acardiac twins - Fetoscopic endoluminal tracheal occlusion (FETO) for congenital diaphragmatic hernia - Fetal cystoscopy and vesico-amniotic shunting for lower urinary tract obstruction - Fetal thoraco-amniotic shunt placement for fetal hydrothorax - Fetal atrial septostomy for intact atrial septum - Fetal valvuloplasty for aortic and pulmonary stenosis - PUBS (fetal blood transfusion for anemia) - CHAOS (congenital high airway obstruction) - Ultrasound –guided ablation of feeding vessels for pulmonary sequestrations and large sacrococygeal - Fetoscopic myelomeningocele repair - Serial amnioinfusions `` Open fetal surgery - In utero repair of myelomeningocele - In utero fetal tumor resection (sacrococcygeal teratomas and lung masses) - Ex utero intrapartum treatment (EXIT) delivery for high-airway obstructions REFER A PATIENT Use our referring provider portal to submit referral requests and view your patients’ Mayo Clinic medical records at the same time we do. Contact Mayo Clinic in Rochester, Minnesota at 800-533-1564 or mayoclinic.org/medical- professionals or call the fetal nurse coordinator line at 507-422-6703, 8 a.m. to 5 p.m. Central time, Monday through Friday.

APPOINTMENT SCHEDULING AND FOLLOW-UP COMMUNICATION We work directly with patients to schedule their appointments, and then coordinate with their referring physician for follow-up regarding outcomes of their visit.

INSURANCE Mayo Clinic has agreements with many insurance carriers, third-party administrators and employers. Patients should check with their insurance plan for specific coverage details before confirming an appointment with our scheduling office. FETAL SURGERY RESEARCH mayoclinic.org/insurance Mayo’s fetal surgery experts have advanced their field through ongoing research studies including, fetoscopic regenerative repair, outcomes registry for spina bifida CONTINUOUS PROFESSIONAL DEVELOPMENT repair, safety and effectiveness of fetoscopic endoluminal tracheal occlusion, Mayo Clinic School of Continuous Professional Development offers a unique and more. learning experience for today’s health care professional. Educational activities enhance and enrich your medical knowledge and improve your service to the `` Current research studies to evaluate the cardiac function in with patient. specific conditions before, during, and after fetal interventions using an ce.mayo.edu automated myocardial performance index. `` Evaluation of the fetoscopic regenerative repair of spina bifida during the CLINICAL TRIALS second trimester of . Researchers are trying to determine if this less Research is an integral part of Mayo Clinic. Mayo Clinic physicians are actively invasive surgical approach will have less risk to the mother and, at the same engaged in a wide range of novel clinical research, offering patients promising time, adequate closure of the fetal spina bifida defect. experimental agents and devices. Mayo Clinic investigators work together with you to optimize patient care. `` Pilot study to gather information on the safety and effectiveness of fetoscopic www.mayo.edu/research/clinical-trials endoluminal tracheal occlusion (FETO), an innovative procedure intended to improve development of the lungs in fetuses diagnosed with severe congenital diaphragmatic hernia (CDH). If better lung development can be promoted, it is MAYO CLINIC LABORATORIES expected that overall survival of babies with severe CDH after birth will also be Mayo Clinic Laboratories (MCL) is the global reference laboratory of Mayo Clinic. improved. MCL provides highly specialized testing and pathology consultation across all medical sub-specialties for patients around the world. `` Serial . mayocliniclabs.com `` Formation of a data registry on the long-term physical and mental health outcomes for mother and child pairs after fetal surgical repair for spina bifida. `` Outcomes research to study maternal and fetal patients who are undergoing fetal intervention for severe, isolated lower urinary tract obstruction (LUTO). The objectives are to evaluate the safety, feasibility, and effectiveness of fetal cystoscopy as an experimental procedure in avoiding perinatal death and renal impairment and to compare to our fetal vesico-amniotic shunting clinical experience. Maternal Fetal Medicine Meet our Care Team

Physicians

Norman Davies, M.B.B.S., Mauro Schenone, M.D. Carl Rose, M.D. M.D.

Rodrigo Ruano, M.D., Ph.D. Linda Szymanski, M.D., Ph.D Mari Charisse Trinidad, M.D.

Advanced Practice Providers

Shana Salik, APRN, C.N.P., Deborah Miller, APRN, C.N.P. M.S.N

Nurses

Jennifer Anderson, R.N. Jennifer Aschoff, R.N. Theresa Barby, R.N.

Angela Schiltz, R.N. Gloria Magruder, R.N. Nancy Knutson, R.N.

Melissa Schultz, R.N. Cynthia Sutherland, R.N. Melissa Wohlferd, R.N.

Sonographers

Michael Nienow, R.D.M.S. Allan Neis, R.D.M.S. Tracy Coleman, R.D.M.S.

Tamara Freimund, R.D.M.S. Maureen Johnson, R.D.M.S. Amanda Kirby, R.D.M.S.

Amber Marroquin, R.D.M.S. Roxanne Palmer, R.D.M.S. Kathleen Praska, R.D.M.S.

Krystal Ruka, R.D.M.S. Emily Smith, R.D.M.S. Kristine Stolt, R.D.M.S.

Heal the sick, Advance the science, Share the knowledge.

Maternal Fetal Medicine Specialist Department of Obstetrics & Gynecology

Current Opportunities: QUALIFICATIONS Candidates must be Board Eligible or Board Certified (BE/BC) in OB/GYN and MFM and have experience in advanced The Division of Maternal Fetal Medicine offers extensive exposure interventions such as laser ablation of placental anastomoses in to managing complex pregnancy complications in a the treatment of twin-twin transfusion syndrome, ultrasound- comprehensive perinatal practice. guided shunt placement in the fetal thorax or bladder, intrauterine transfusion, participation in open fetal surgical repair of We have a division of six MFM physicians, along with a support myelomeningocele and chorionic villus sampling. staff and a multidisciplinary, collaborative Fetal Board with involvement of Neonatology, Pediatric cardiology, Pediatric MAYO CLINIC surgery, Genetics, and other pediatric subspecialties as necessary. Mayo Clinic has been recognized as the best hospital in the Our growing practice recently added advanced fetal interventions. nation for 2020-2021 by U.S. News and World Report. Our multi- disciplinary group practice focuses on providing high quality, The Mayo Clinic Maternal Fetal Medicine practice is based on a compassionate medical care. We are the largest integrated, not- strong regional patient network enhanced by a complex referral for-profit medical group practice in the world with approximately practice, including focused expertise in prenatal genetics, fetal 3,800 physicians and scientists across all locations working in a structural anomalies, congenital heart disease, solid-organ unique environment that brings together the best in patient care, transplant and cancer during pregnancy. groundbreaking research and innovative medical education. We offer a highly competitive compensation package, which includes The Rochester obstetrics practice performs 2,400 deliveries per exceptional benefits, and have been recognized by FORTUNE year with an additional 6,600 deliveries annually in the Mayo magazine as one of the top 100 “Best Companies to Work For”. Clinic Health System. Clinical and research activities are enriched by collaboration with nationally renowned Mayo Clinic experts To apply and learn more, please visit from every aspect of medicine, surgery, and science. The division https://jobs.mayoclinic.org/ and reference job posting supports an ABOG-accredited fellowship in Maternal Fetal 143284BR. Medicine along with an ACGME-accredited OB/GYN residency Or Contact Maddie Dosch, Physician Recruiter program. [email protected]; Phone: 507-293-7988

Mayo Foundation is an affirmative action and equal opportunity educator and employer. Post offer/pre-employment drug screening is required. mayoclinic.org/jobs ©2015 Mayo Foundation for Medical Education and Research MC0000-0000 DEPARTMENT OF Obstetrics and Gynecology

REFERRAL GUIDE CONTENTS

Gynecology ...... 6 Minimally Invasive Gynecologic Surgery ...... 8 Gynecologic Oncology ...... 9 Urogynecology ...... 10

Obstetrics ...... 11 Maternal Fetal Medicine ...... 12 Reproductive Endocrinology ...... 14 and Infertility

Research Activities ...... 16 Clinical Trials ...... 17 Medical Professional Resources ...... 17 Online Services for Referring Physicians . . . . . 17 Transfer a Patient ...... 17

2 The Department of Obstetrics and Gynecology supports women throughout their lifelong journey from childbearing age to menopause and beyond . The team-based approach includes you as a partner in offering care, healing, hope and solutions to complex problems . Our diverse team is consistently ranked No .1 by U .S . News & World Report . It includes physicians, surgeons, proceduralists, certified nurse midwives, physician assistants, nurse practitioners, sonographers, embryologists and a dedicated nursing team . This team of professionals benefits from the knowledge and expertise accumulated over the course of 100 years since the founding of the department .

1 Mayo Clinic, Rochester, Minnesota Referral Guide Department of Obstetrics and Gynecology

Minimally Invasive Gynecology Gynecologic Surgery 507-266-8680 507-266-8680

Abnormal uterine bleeding Cervical loop electrosurgical excision ■ Fibroid center procedure (LEEP)/conization ■ Office CO2 laser treatment of lower genital tract dysplasia ■ Genital dysplasia Conservative treatment ■ HPV of endometriosis ■ Loop electrosurgical excision procedure (LEEP) Diagnostic hysteroscopy Complex contraceptive care Diagnostic Genetics — Inherited gynecologic cancer screening Hysteroscopic Minimally invasive gynecologic Laparoscopic surgery (MIGS) Laparoscopic sterilization Pelvic pain/vulvodynia Operative hysteroscopy Perimenopause/menopause Operative laparoscopy Preventive medicine services Sonohysterography Young women/adolescent services Surgical and nonsurgical treatment of uterine fibroids Surgical management of Surgical management of missed/incomplete abortion Surgical management of simple congenital anomalies Surgical treatment of endometriosis Surgical treatment of vulvar disorders

2 Online Referral Portal www.MayoClinic.org/medicalprofs

Gynecologic Oncology Urogynecology 507-538-8400 507-538-8400

Treatment of gynecologic Congenital anomalies cancers including ■ Imperforate hymen ■ Hysterectomy ■ Uterine anomalies ■ Cytoreductive ovarian cancer surgery ■ Vaginal septum ■ Minimally invasive endometrial Minimally invasive hysterectomy cancer surgery including a sentinel ■ Vaginal lymph node program ■ Robotic ■ Minimally invasive nerve sparing radical hysterectomy Pelvic organ prolapse ■ ■ Trachelectomy for Surgical ■ preservation in early cervical cancer Nonsurgical ■ Surgery for recurrent cancer Rectovaginal and including intra-operative radiation, vesicovaginal fistula radical tumor excision Refractory overactive bladder (OAB) ■ Hyperthermic intraperitoneal ■ InterStim chemotherapy (HIPEC) ■ onabotulinumtoxinA (Botox) ■ ■ Inguinal lymphadenectomy and Robotic surgery sentinel lymph node excision Urinary incontinence ■ Laser therapy ■ Stress Advanced endometriosis ■ Urgency Surgical treatment of fibroids Fertility-sparing surgery Risk reducing surgery for inherited cancer syndromes

3 Mayo Clinic, Rochester, Minnesota Referral Guide Department of Obstetrics and Gynecology

Obstetrics and Maternal Fetal Medicine 507-284-5135

Centering pregnancy High-risk and hypertension/cardiac ■ Midwifery practice obstetric clinics ■ OB Nest ■ Hypertension and preeclampsia ■ Preconception counseling ■ Maternal and fetal infections ■ Family birth center Multifetal gestations ■ Pre-gestational and gestational ■ Antepartum care diabetes ■ Cesarean deliveries ■ Stable maternal cardiac disease ■ Maternal surgeries including cerclage ■ Operative vaginal deliveries Low-risk obstetric care ■ Postpartum care Maternal fetal medicine ■ Urgent or emergent obstetric ■ Cancer or transplant patients evaluations who are pregnant ■ Vaginal birth after cesarean ■ Complex maternal or fetal (VBAC) deliveries cardiac disease ■ Vaginal deliveries ■ Inherited and acquired Genetic counseling and prenatal testing thrombophilias ■ Chorionic villus sampling ■ Maternal rhesus (Rh) factor disease ■ First trimester screening or atypical alloimmunization ■ Genetic amniocentesis ■ Placenta previa/accrete ■ Medication or drug exposure Fetal surgery and counseling regenerative medicine ■ Personal or family history ■ Fetal cystoscopy and surgery of birth defects for bladder outlet obstruction ■ Percutaneous umbilical blood ■ Fetal endoscopic tracheal occlusion sampling (PUBS) and in utero for congenital diaphragmatic hernia transfusion ■ Fetal shunt placements ■ Fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome ■ Fetoscopic release of amniotic bands ■ In utero repair of spina bifida ■ Radiofrequency ablation

4 Online Referral Portal www.MayoClinic.org/medicalprofs

Reproductive Endocrinology and Infertility 507-284-9792

Fertility Reproductive surgeries ■ In vitro fertilization (IVF) ■ Hysteroscopic surgeries for fibroids, ■ Intrauterine insemination (IUI) polyps, Müllerian anomalies and ■ Donor oocytes/sperm intrauterine adhesions ■ Elective egg (oocyte) freezing (Asherman’s syndrome) ■ Fertility preservation ■ Laparoscopic surgeries for ■ Gestational carriers (surrogates) endometriosis and fibroids ■ Preimplantation genetic diagnosis ■ Myomectomies (PGD) and preimplantation genetic ■ Ovarian tissue cryopreservation screening (PGS) and transplantation ■ Reproductive surgeries for Male reproduction Müllerian anomalies ■ Electroejaculation ■ Robot-assisted surgeries for ■ Epididymovasal reconstruction endometriosis and fibroids ■ Microscopic epididymal sperm ■ Tubal reversal surgeries aspiration (MESA) in office ■ Microscopic testicular sperm extraction (Micro-TESE) ■ Retrograde ejaculation sperm retrieval ■ Robotic vassal reconstruction ■ Semen/testicular tissue cryopreservation ■ Testicular sperm extraction (TESE) in office ■ Transrectal ultrasonography ■ Transurethral resection of ejaculatory ducts ■ Varicocele repair ■ Vasectomy reversal ■ Vasography (fine needle)

5 Gynecology

Clinical Services Mayo Clinic’s care team includes Gynecologic genetics — Our genetics physicians, surgeons, genetics professionals provide comprehensive professionals, physician assistants genetic services, including pedigree and advanced practice nurses . analysis, genetic counseling and genetic Together they evaluate, diagnose testing for patients at risk of hereditary and treat a variety of disorders of gynecologic conditions . We have the female reproductive tract . expertise evaluating patients who have a personal or family history, or both, of Chronic pelvic pain — Our multidisciplinary approach to patients gynecologic cancer associated with with chronic pelvic pain involves hereditary cancer syndromes . We also colleagues who specialize in pain provide preconception counseling for medicine, physical medicine and patients interested in genetic screening rehabilitation, behavioral health, and patients considering PGS or PGD . gastroenterology and minimally invasive In addition, we provide genetic services gynecologic surgery . Patient records for for patients with premature ovarian these complex cases are reviewed in insufficiency and disorders of sexual advance, and a personalized itinerary differentiation . is generated . We partner with the Hysteroscopic services — Our clinic patient’s primary provider for long-term provides office diagnostic hysteroscopy management . and operative hysteroscopy for poly- pectomy, sterilization and intrauterine Endometriosis — We take a comprehensive approach to patients device retrieval . For patient convenience with endometriosis . When surgical and comfort, we offer one-stop management is needed, patients diagnosis and therapy when feasible . with endometriosis are treated with Pre-invasive lower genital tract excisional techniques . And we involve disease — We offer laser and colon and rectal surgeons for bowel excisional techniques for cervical, lesions as appropriate . vaginal and vulvar pre-invasive disease . Frozen section is immediately available Fibroids — We offer the full range of for margin evaluation as needed . minimally invasive therapies for fibroids, including hysteroscopic myomectomy, Vulvar skin conditions — Patients MR-focused ultrasound, uterine artery with complicated vulvar dermatoses embolization, robotic myomectomy and are evaluated and treated with a laparoscopic hysterectomy . combined effort between gynecology and dermatology . Patients are seen by both specialists in the same visit .

6 TO REFER A PATIENT: 507-266-8680

Services

Abnormal uterine bleeding Complex contraceptive care ■ Fibroid center Genetics — Inherited gynecologic ■ Office hysteroscopy cancer screening Colposcopy MIGS ■ Genital dysplasia ■ HPV Pelvic pain/vulvodynia ■ LEEP Perimenopause/menopause Preventive medicine services Young women/adolescent services

7 TO REFER A PATIENT: 507-266-8680

Minimally Invasive Gynecologic Surgery

Clinical Services Gynecologists trained in minimally Care is provided either in the exam invasive gynecologic surgery (MIGS) room or within outpatient surgical specialize in evaluating and treating suites . No matter the setting, we women who have a wide range of emphasize optimal outcomes and benign gynecologic conditions . reduced discomfort, inconvenience and expense to the patient .

Services

Cervical LEEP/conization Operative laparoscopy

CO2 laser treatment of lower Sonohysterography genital tract dysplasia Surgical and nonsurgical treatment Conservative treatment of uterine fibroids of endometriosis Surgical management of Diagnostic hysteroscopy ectopic pregnancy Diagnostic laparoscopy Surgical management of Endometrial ablation missed/incomplete abortion Hysteroscopic sterilization Surgical management of simple congenital anomalies Laparoscopic hysterectomy Surgical treatment of endometriosis Laparoscopic sterilization Surgical treatment of vulvar disorders Operative hysteroscopy

8 TO REFER A PATIENT: 507-538-8400

Gynecologic Oncology

Clinical Services Services Gynecologic oncologists offer an integrated approach to the diagnosis Treatment of gynecologic and surgical management of women’s cancers including cancers and complex benign ■ Hysterectomy gynecologic diseases . These include ■ Cytoreductive ovarian cancer surgery cervical, uterine (endometrial), ovarian, ■ Minimally invasive endometrial vaginal and vulvar cancers, uterine cancer surgery including a sentinel leiomyomata (fibroids), endometriosis lymph node program and pelvic masses . ■ Minimally invasive nerve sparing radical hysterectomy Mayo Clinic’s gynecologic oncologists ■ Trachelectomy for fertility possess surgical expertise in complex preservation in early cervical cancer laparoscopic and robotic approaches, ■ Surgery for recurrent cancer as well as fertility-sparing surgery . including intra-operative radiation, Chemotherapy and radiation therapy radical tumor excision are managed in close collaboration with ■ Hyperthermic intraperitoneal our colleagues from Medical Oncology chemotherapy (HIPEC) and Radiation Oncology at Mayo Clinic . ■ Vulvectomy ■ Inguinal lymphadenectomy and sentinel lymph node excision ■ Laser therapy Advanced endometriosis Surgical treatment of fibroids Fertility-sparing surgery Risk reducing surgery for inherited cancer syndromes

9 TO REFER A PATIENT: 507-538-8400

Urogynecology

Clinical Services Services Mayo Clinic uses a coordinated, multidisciplinary approach to the Congenital anomalies evaluation and treatment of pelvic floor ■ Imperforate hymen disorders . These disorders include ■ Uterine anomalies pelvic organ prolapse, urinary and ■ Vaginal septum fecal incontinence, vesicovaginal and Minimally invasive hysterectomy rectovaginal fistulas and congential ■ Vaginal anomalies of the lower reproductive ■ Robotic tract (for example, imperforate hymen, vaginal septum, uterine Pelvic organ prolapse ■ anomalies) . We also specialize in Surgical ■ managing complications from previous Nonsurgical incontinence or prolapse surgery with Rectovaginal and or without mesh . vesicovaginal fistula Refractory OAB A women’s health nurse practitioner ■ InterStim and physician assistant offer diagnostic ■ Botox assessment and nonsurgical treatments for pelvic floor disorders, Robotic surgery including pessaries, pelvic floor therapy, Urinary incontinence electrical stimulation (“e-stim”) and ■ Stress behavioral and medical management ■ Urgency of urinary incontinence . Our team members are experts in their fields and look forward to providing patients with comprehensive and compassionate care .

10 TO REFER A PATIENT: 507-284-5135

Obstetrics

Clinical Services The doctors and certified nurse technology innovations in obstetric midwives at Mayo Clinic offer and remote monitoring for busy low- women compassionate, expert and risk expectant mothers who prefer personalized care before, during and more active involvement in their after pregnancy . The operative skill prenatal care . of the obstetrics staff is honed in a practice of referral obstetrics and is The new Family Birth Center offers supported by myriad resources women a new standard for giving at Mayo Clinic . birth in a warm, family-centered environment, including high-tech Women who come to Mayo Clinic electronic resources that can enhance for obstetric care have access to the relationship between women and medical specialties and subspecialties their providers during pregnancy . if their are challenged by medical conditions . And they have available to them prenatal diagnostic care, including sophisticated imaging . Services For managing the transition from intrauterine to extrauterine life, Family Birth center we have neonatal specialty care and Fetal surgery and advanced nursery services available regenerative medicine for our patients . Genetic counseling and While able to provide the most prenatal testing advanced prenatal care available, the High-risk and hypertension/ midwives and physicians who care for cardiac obstetric clinics patients in obstetrics recognize the Low-risk obstetric care sociological, psychological and cultural implications of and support Maternal fetal medicine our patients in this most miraculous of life’s transitions . Novel approaches to prenatal care include Mayo’s CenteringPregnancy, which offers an opportunity for couples to participate in prenatal care in a group setting, and OB Nest, a prenatal model of care unique to Mayo Clinic, that combines

11 Maternal Fetal Medicine

Clinical Services Mayo Clinic offers expert care to A dedicated team of physicians women whose pregnancies are and nurses ensures the coordinated complicated by genetic, obstetric, approach necessary for intrauterine medical and surgical conditions . therapy when appropriate and optimal planning for delivery and neonatal Mayo Clinic’s specialists coordinate care . Patients receive support from a multidisciplinary team to provide a compassionate team of providers answers to women facing extremely including dietitians, genetics high-risk pregnancies . The expertise counselors, social workers and of neonatologists, pediatric surgeons, nurse specialists . pediatric subspecialists and the most sophisticated imaging technology all contribute to the management of challenging pregnancies .

12 TO REFER A PATIENT: 507-284-5135

Services

Centering pregnancy High-risk and hypertension/cardiac ■ Midwifery practice obstetric clinics ■ OB Nest ■ Hypertension and preeclampsia ■ Preconception counseling ■ Maternal and fetal infections ■ Family birth center Multifetal gestations ■ Pre-gestational and gestational ■ Antepartum care diabetes ■ Cesarean deliveries ■ Stable maternal cardiac disease ■ Maternal surgeries including cerclage Low-risk obstetric care ■ Operative vaginal deliveries Maternal fetal medicine ■ Postpartum care ■ Cancer or transplant patients ■ Urgent or emergent obstetric who are pregnant evaluations ■ Complex maternal or fetal ■ Vaginal birth after cesarean cardiac disease (VBAC) deliveries ■ Inherited and acquired ■ Vaginal deliveries thrombophilias Genetic counseling and ■ Maternal rhesus (Rh) factor disease prenatal testing or atypical alloimmunization ■ Chorionic villus sampling ■ Placenta previa/accrete ■ First trimester screening Fetal surgery and ■ Genetic amniocentesis regenerative medicine ■ Medication or drug exposure ■ Fetal cystoscopy and surgery counseling for bladder outlet obstruction ■ Personal or family history ■ Fetal endoscopic tracheal occlusion of birth defects for congenital diaphragmatic hernia ■ Percutaneous umbilical blood ■ Fetal shunt placements sampling (PUBS) and in utero ■ Fetoscopic laser ablation of transfusion placental anastomoses for twin-twin transfusion syndrome ■ Fetoscopic release of amniotic bands ■ In utero repair of spina bifida ■ Radiofrequency ablation

13 Reproductive Endocrinology and Infertility

Clinical Services Mayo Clinic is a leader in managing reproductive-age patients with serious complex fertility problems, including medical illnesses where treatment may infertility, fertility preservation, recurrent impair future fertility . pregnancy loss, uterine fibroids, endometriosis, congenital uterine Reproductive Surgery anomalies and conditions where there We can surgically treat uterine fibroids, is risk of genetic disorders in offspring . endometriosis, uterine polyps, uterine adhesions and abnormalities of the We offer an integrated approach to or fallopian tubes . We do these diagnosis and treatment of fertility-related procedures using techniques shown disorders and have the most advanced to optimize reproductive potential . We IVF laboratory featuring an incubation also perform outpatient microsurgery system that allows real-time observation to reverse tubal ligations and offer of embryo development . We are one innovative fibroid treatment options of the few clinics in the United States such as robotic myomectomy and to offer this technology . In addition, we MR-focused ultrasound surgery . are leaders in fertility preservation for

14 TO REFER A PATIENT: 507-284-9792

Services

Fertility Reproductive surgeries ■ IVF ■ Hysteroscopic surgeries for fibroids, ■ IUI polyps, Müllerian anomalies and ■ Donor oocytes/sperm intrauterine adhesions ■ Elective egg (oocyte) freezing (Asherman’s syndrome) ■ Fertility preservation ■ Laparoscopic surgeries for ■ Gestational surrogates endometriosis and fibroids ■ PGD and PGS ■ Myomectomies ■ Ovarian tissue cryopreservation Male reproduction and transplantation ■ Electroejaculation ■ Reproductive surgeries for ■ Epididymovasal reconstruction Müllerian anomalies ■ MESA in office ■ Robot-assisted surgeries for ■ Micro-TESE endometriosis and fibroids ■ Retrograde ejaculation ■ Tubal reversal surgeries sperm retrieval ■ Robotic vassal reconstruction ■ Semen/testicular tissue cryopreservation ■ TESE in office ■ Transrectal ultrasonography ■ Transurethral resection of ejaculatory ducts ■ Varicocele repair ■ Vasectomy reversal ■ Vasography (fine needle)

15 Research Activities

Gynecologic Oncology Obstetrics ■ Active in institutional and national clinical ■ Focus on advancing diagnosis and trials that offer patients optimal care treatment of common and complex ■ Contribute to basic science and clinical complications of pregnancy research in gynecologic cancers ■ Pursue academic inquiry into ■ Member of the Mayo Clinic methods of health care delivery Cancer Center and preventive services that include ■ One of only five institutions in the nutrition, exercise, wellness and United States to be awarded an electronic resources to enhance ovarian cancer Specialized Programs care during pregnancy of Research Excellence (SPOREs) ■ Collaborate with Medical Genetics grant from the National Institutes of in research focused on common Health (NIH) chromosomal and genetic diseases in pregnancy Minimally Invasive ■ Investigate the safety of offering Gynecologic Surgery cancer-reducing surgery to women ■ Evaluate new technologies and assess delivering by cesarean section their application to clinical practice Reproductive Endocrinology ■ Focused on improving diagnosis and Infertility and expanded treatment options ■ Nationally and internationally of benign gynecologic disorders recognized for contributions ■ Study cutting-edge treatment to advancing the frontier of options for uterine fibroids reproductive medicine Maternal Fetal Medicine ■ Leaders in several projects ■ Contribute to basic science leading funded by the NIH to better understanding of Urogynecology pathogenesis and management ■ Research interests from basic science of pregnancy complications (hormone receptor expression, mesh ■ Leaders in the effective use of health implant biology and regenerative care resources to manage obstetric medicine) to epidemiology studies, patients in the areas of preterm clinical trials, patient-centered labor assessment, fetal assessment outcomes, ergonomics and materials during antenatal maternal surgery, used in the treatment of pelvic floor effective use of blood products during disorders pregnancy, decreasing maternal exposure to radiation, placenta previa and abnormal placentation, integration/acculturation of immigrant obstetric patients and fetal surgery ■ Pioneered the use of simulation 16 training Clinical Trials

For a listing of Mayo Clinic clinical For general information about clinical trials involving obstetric and trials in OB/GYN, call 507-293-1487 . gynecologic conditions, see For information about cancer-related www.clinicaltrials.mayo.edu . clinical trials, call 507-538-7623 .

Medical Professional Resources www.MayoClinic.org/medicalprofs

■ Online services ■ Medical and surgical department ■ Physician directories descriptions ■ Physician biographies including ■ Physician newsletters training and areas of specialization ■ Continuing medical education ■ Patient referrals Additional Resources ■ Patient transports Medical services at Mayo Clinic ■ Insurance coverage www.MayoClinic.org/diseases- ■ Patient follow-up treatments ■ Grand Rounds videos Clinical trials at Mayo Clinic www.clinicaltrials.mayo.edu

Online Services for Referring Physicians Mayo Clinic Online Services for Online Services for Referring Referring Physicians is a secure, Physicians allows health care user-friendly website that provides providers to: a window into the care of patients ■ Make appointment requests referred to Mayo Clinic through Online electronically, 24/7 . Services . To register for this service, ■ Request records on patients please log onto: www.MayoClinic.org/ previously referred to Mayo Clinic . medical-professionals . ■ View and print Mayo Clinic medical documents for patients referred through Online Services, including consultative and surgical notes, laboratory and radiology reports To transfer a patient call and hospital discharge summaries . Admission and Transfer Center: 507-255-2910, 24 hours, 7 days a week 17 Department of Obstetrics and Gynecology at Mayo Clinic

Phoenix/Scottsdale, Arizona Phone: 866-629-6362 Fax: 480-301-4071

Jacksonville, Florida Phone: 800-634-1417 Fax: 904-953-0575

Rochester, Minnesota Phone: 800-533-1564 Fax: 800-321-1368

Email: [email protected]

www.MayoClinic.org/medicalprofs

18 MC5257-18rev0917