Jennifer B Gilner

Advanced surgical methods for care of Placenta Accreta Spectrum and other severe pregnancy complications (Complex Obstetric Surgery):
Pathologic attachment of the placental tissue in pregnancy is a highly morbid condition directly related to increasing rates of cesarean delivery. Even with known diagnosis prior to delivery, this condition carries an extremely high risk of catastrophic hemorrhage for the mother.
   Duke is a Level IV Maternal Care center with extensive experience in the management of placenta accreta spectrum (PAS) disorders. Over the past 13 years we have developed a management algorithm for patients with PAS that incorporates all of the critical elements highlighted by this recently published OB Care Consensus, and fulfills criteria to make us a Center of Excellence for care of this highly morbid condition. Furthermore, our multidisciplinary approach with a consistent - and therefore increasingly experienced – core team of specialty physicians (MFM, OB anesthesia, Interventional Radiology, Gyn Onc), nurses, surgical staff, and transfusion services allows us to lead innovations such as placental-uterine artery embolization. With our sound framework of clinical study and continuous quality improvement we are building a regional PAS referral center founded in current evidence and growing through ongoing research.

Maternal-Fetal Immune Tolerance:
A normally functioning maternal immune system is critical to a healthy pregnancy, since there are necessary transitions in immune reactivity as the conceptus invades, inhabits, then evacuates the uterus. A healthy maternal-fetal immune interaction in the period of premature viability is expected to be predominated by maternal immune tolerance (protection) of the immunologically ‘foreign’ fetus. Disruption in normal maternal T cell tolerance is a likely functional mechanism causing a subset of preterm births. Our preliminary data supports the existence of critical tolerogenic T cells in the uterus as well as in the maternal circulation, and we have observed disruption of these tolerogenic T cell functions in preterm birth samples. Our central hypothesis is that tolerogenic T cell dysfunction is a mechanism of disease in the subset of preterm births marked by a maternal anti-fetal rejection phenotype.