Care Coordination at Its Finest: Cardiology and Maternal Fetal Medicine Come Together to Deliver a Healthy Baby


By Jaclyn Seebsitt

Seamless care coordination is what allows our integrated delivery system to work like a well-oiled machine. Time and again, we are excited to share shining examples of how we’re changing the health care landscape through multidisciplinary care teams that advocate for our patients every step of the way. The latest example of our commitment to care excellence comes from our Tysons Corner Medical Center’s Adult Congenital Cardiology/Maternal Fetal Medicine multidisciplinary team.

Dr. Kristin Knight, Mid-Atlantic Permanente Medical Group (MAPMG) perinatologist, and Dr. Ameya Kulkarni, MAPMG interventional cardiologist, worked together with their care teams to help a pregnant patient with a history of rheumatic heart disease and a poorly functioning mechanical heart valve manage her condition throughout her pregnancy and deliver a healthy baby girl.

The patient required close monitoring throughout her pregnancy due to her condition. Drs. Knight and Kulkarni co-managed her care throughout her pregnancy, which was complicated by rising mitral gradients and concern for pulmonary hypertension.

Because of the complexity of the patient’s condition early on, the team looped in obstetric anesthesia and our partners at Virginia Hospital Center to ensure that she could proceed through her pregnancy with coordinated days for testing and a minimal increase in appointments. For example, if the patient needed to come in for her fetal ultrasound, they scheduled her cardiac ultrasound on the same day, if possible.

“What was really remarkable is that we were both able to see her same day, talk about her condition in real time, and coordinate visits,” Dr. Knight said. “This level of collaboration would not be possible outside our [Kaiser Permanente] system.”

At the end of her pregnancy, the team had planned to deliver the patient’s baby electively on a Monday, but the baby had other plans: the patient went into labor the previous Friday. Since the team was so tightly coordinated and had a plan in place well in advance, they quickly adapted and adjusted the birth plan without any disruption.

The patient received invasive hemodynamic monitoring, and the team was prepared for a number of complications. “Every minute is a difference between life and death in these patients,” said Dr. Kulkarni. “There is no such thing as being over-prepared in these situations.” However, everything went smoothly and the baby was delivered safely and healthily. The patient and her baby are now enjoying their time together at home.

“In the end, your extraordinary preparation allowed for seamless adaptation when the baby came on her own schedule,” said Dr. Cheryl Keys, Northern Virginia Service Area Physician-in-Chief, in a message to Drs. Knight and Kulkarni. “Our patients are so fortunate to have this level of coordinated care by the best physicians anywhere.”

Drs. Knight and Kulkarni started partnering in their coordinated care program two years ago to better manage these high-risk patients and develop best practices. Although they are based in the Northern Virginia service area, Drs. Knight and Kulkarni are able to help co-manage care for any patients in our region who required this specialty care through virtual behind-the-scenes coordination and communication with our other care teams.

“The advantage of having the same team manage every single one of these patients is that we develop a philosophical alignment and have already built in conversations about the challenges that could arise, so when patient a presents with these conditions, we only need to talk about the specific nuances of that patient,” said Dr. Kulkarni. “We can really offer a tailored, coordinated program for these patients.”

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