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By JULIE MINDA

It's a much anticipated pregnancy milestone for countless expectant moms: seeing their baby for the first time — on a video monitor — when they have their second trimester ultrasound.

But for Ashton Johnson, a visually impaired woman pregnant with her first child, her 20-week ultrasound at an Omaha, Nebraska, clinic late last year was a bit frustrating. She has a genetic condition that prevents her from seeing images that lack sharp contrast, so it was impossible for her to discern as a baby the ill-defined black, gray and white pixels that she saw on the ultrasound monitor.

Her husband, Logan Johnson, narrated what he saw on the screen — the baby rolling, the baby appearing to sleep — but Ashton craved details.

Life hacks
Prior to that imaging appointment at the CHI Health Clinic Women's Health, Ashton and her husband had done research about best practices and life hacks for visually impaired parents. They came across articles about physicians in Brazil who were making three-dimensional models of ultrasound images for patients who couldn't see traditional ultrasounds.

The Johnsons casually talked about the value of those models during the fetal ultrasound. The technician made a mental note and related that conversation to Dr. Katie Sekpe, Ashton's obstetrician. A colleague at CHI Health Clinic Women's Health, Dr. John Coté, had printed 3D models of Sekpe's own twins from fetal ultrasound images.

Sekpe approached Coté about creating the 3D models for Ashton, her first patient with a serious visual impairment.

Molding better outcomes
Coté is a clinical obstetrician-gynecologist with CHI Health and an assistant professor at Creighton University who has been researching, among many other subjects, the use of 3D printing for better patient outcomes.

He says his interest in 3D printing began when his family got a home 3D printer for Christmas several years ago. At first, he was mainly printing Star Wars figures and other toys for his kids but then the self-described "tech nerd" started experimenting with sending medical images — including computerized tomography and magnetic resonance imaging scans and ultrasounds — to the printer.

When Sekpe approached him, he was eager to help. He printed one of the several 3D models Ashton received in December. His is an FDM printer, short for fused deposition modeling. The printer extrudes and layers plastic filaments to replicate in three dimensions the flat two-dimensional image that it is interpreting. Coté says he's learned over time how to refine electronic files like ultrasounds to remove the image distortions that can translate to physical shapes on a 3D model.

At Coté's suggestion, Sekpe also enlisted a technician at the hospital to create additional models of Ashton's ultrasound on the Stratasys brand PolyJet 3D printer used to create medical models at CHI Health Creighton University Medical Center — Bergan Mercy. The polymer it uses in printing has a different hardness when it is cured than the materials Coté's printer uses. Coté says the colleagues wanted to give Ashton models of varying pliability so she could experience the contours of the baby's face in different ways.

Based on what he's learned about application for 3D printing in maternal-fetal medicine from his own and others' research, he views it as a very effective tool to promote bonding prior to a baby's birth, among many other benefits.

In early December, the clinicians surprised Ashton by inviting her and her husband to CHI Health Creighton University Medical Center — Bergan Mercy. The expectant mother knew as she headed over that she'd be receiving a 3D print made from her baby's ultrasound but did not know she'd be getting multiple models. At the hospital, Sekpe and Coté and a hospital staffer presented her with the 3D ultrasound models. She says running her fingertips over the models to feel the shape of her baby's face and features "was very emotional — I couldn't stop crying."

The Johnsons display the models in the nursery and have taken them along to baby showers. As Catholic Health World went to press, Ashton was due to deliver her son in early February. The couple planned to name him Quinton.

Extra preparations
Ashton was born with leber congenital amaurosis. According to a medical information website from the University of California San Francisco, LCA is a rare inherited eye disorder that causes severe vision loss at birth. LCA is the most common cause of inherited blindness in childhood and is found in two to three out of every 100,000 babies, according to the site.

Ashton says she's always been determined not to let her visual impairment define or limit her. "I set really high goals for myself," she says. She earned her doctorate in physical therapy at Creighton University and did her clinical rotation at CHI Health Creighton University Medical Center — Bergan Mercy. The medical center is part of CommonSpirit Health.

In preparing for bringing home baby Quinton, Ashton and Logan are applying some of the tips from their research.

Ashton bought a breastpump with raised buttons that are easy to locate. The pump has fewer small parts than other models, which simplifies cleaning. The baby's bottles have raised numbers and letters, so Ashton can know how many ounces of milk she's giving Quinton.

The couple is using a black Sharpie to label items in the kitchen and nursery with large lettering — a hack that will help a sleep-deprived dad too.

3D modeling has applications in obstetrics care, says CHI Health obstetrician

Coté

Research that Dr. John Coté has been reviewing and adding to on his own indicates that there are many potential benefits of using three-dimensional models of fetal ultrasound, computerized tomography and magnetic resonance imaging scans.

Coté is a clinical obstetrician-gynecologist with CHI Health in Omaha, Nebraska, and an assistant professor at Omaha's Creighton University. He says that while the application of 3D printing is still in early use in medical modeling, obstetricians and gynecologists have been able to use 3D printing to educate their surgical teams, medical students and patients.

Patient-specific anatomical models are used to preplan hysterectomies and for a fuller understanding of tissue damage from endometriosis, Coté says.

Research also has shown that having models of their baby in utero can motivate pregnant women to quit smoking, Coté says. Smoking during pregnancy raises the risk of birth defects.

Coté says his research shows that 3D models of fetal ultrasound images have had a measurable impact on bonding for pregnant women who have suffered from past birth trauma or miscarriage. Seeing the model allows them to emotionally process the new pregnancy.

The lifelike modeling can help a woman whose baby has a visible birth defect in utero to emotionally prepare for the baby's appearance. Coté says he once made a model for an expectant mother whose baby would be born with a cleft palate. She brought the model to her baby showers to prepare relatives and friends too.

Coté's research also has shown that 3D fetal modeling helps fathers-to-be. Normally, fathers do not bond as closely with their unborn babies as mothers do because of the physical connection between mother and child, Coté says, adding his research shows that having a model of their baby in utero allows fathers to bond with their child more closely before birth.

— JULIE MINDA