When Cynthia Chandirakumar learned last year that she was pregnant, excitement was accompanied by deep uncertainty.
Her first pregnancy six years earlier had been complicated by severe pre-eclampsia — a life-threatening condition linked to problems with the placenta that can escalate quickly and endanger both mother and baby. Her son was born prematurely and required care in a neonatal intensive care unit (NICU). So, with this pregnancy, Cynthia knew the road ahead would be difficult.
“I had been through trauma with my first pregnancy and birth, so this time I felt like I was constantly walking on edge.”
Because of her history, Cynthia was referred early in her pregnancy to Dr. John Kingdom, a maternal-fetal medicine specialist who leads Mount Sinai Hospital’s internationally recognized Placenta Clinic.
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Where the most complex pregnancies are managed as one system
The Placenta Clinic is part of the Ontario Fetal Centre (OFC), based at Mount Sinai and in partnership with SickKids, and is one of the most advanced maternal-fetal care networks in the country.
Few hospitals in the world unite this level of expertise within a single coordinated system. At Sinai Health, specialists in placental disease, maternal medicine, diabetes in pregnancy, fetal diagnosis and neonatal care work as one integrated team, allowing even the most complex pregnancies to be managed seamlessly in one place.
For patients like Cynthia, that level of coordination makes all the difference.
“The complications that can deny you a baby or make the mother very sick are largely related to the placenta.”
The Placenta Clinic focuses on complications caused by abnormal placental function – including pre-eclampsia, fetal growth restriction and stillbirth risk. Dr. Kingdom explains that the placenta lies at the heart of many serious pregnancy complications. “Our goal is to diagnose placental problems early and provide proactive care rather than discovering the issue only after something has gone wrong,” he says.
Detecting risk earlier through placental science and real-time testing
Advancing care for complex pregnancies depends not only on clinical expertise, but also on continuous research and innovation. That work is strengthened by philanthropic investment, including the Canerector Foundation Research Chair in Medical Disorders in Pregnancy (MDP) program.
This Chair is Canada’s first endowed position providing stable annual funding to recruit and support a global leader in the field. It enables physician-scientists to translate real-world patient challenges into new approaches to care – accelerating progress in research, education and treatment. Supported by the Canerector Foundation, this investment helps expand Sinai Health’s impact and leadership in caring for complex pregnancies like Cynthia’s.
Mount Sinai Hospital has also been at the forefront of a major innovation in placental medicine: the Placental Growth Factor (PlGF) blood test, which helps physicians identify patients at the highest risk of severe pre-eclampsia and other placental complications.
In 2017, Mount Sinai became the first hospital in North America to implement real-time, same-day maternal blood testing for PlGF in high-risk pregnancy care, enabling rapid risk assessment and more informed decisions about monitoring and treatment.
Cynthia’s care benefited directly from access to this advanced testing, helping her care team closely track placental health and respond quickly as her pregnancy progressed.
“Dr. Kingdom was so thorough and so positive. He made my husband and me feel like we were in the right place.”
Coordinated care across specialties when every hour matters
As Cynthia’s pregnancy progressed, her care extended across several programs within Sinai Health’s maternal-fetal network.
Elevated blood sugar levels and a diagnosis of type 2 diabetes led to a referral to the Diabetes in Pregnancy Program, led by endocrinologist Dr. Denice Feig, where specialists helped her manage her condition. “Our patients with type 2 diabetes in pregnancy have a high risk of adverse pregnancy outcomes, including stillbirth and congenital anomalies,” says Dr. Feig. “In our clinic, we help patients with type 2 improve glycemic control, which reduces the risk of pre-eclampsia.”
As Cynthia’s diabetes was being managed, the Placenta Clinic continued monitoring her closely for signs of pre-eclampsia. When her blood pressure began rising, she was admitted to Sinai Health’s Am Israel Chai Antenatal Unit – part of the Frances Bloomberg Centre for Women’s and Infants’ Health – where patients with high-risk pregnancies receive around-the-clock monitoring.
There, specialists from the MDP program joined her care team. Each day, clinicians monitored her blood pressure and kidney and liver function while conducting detailed ultrasounds to assess placental blood flow and the baby’s development.
“The goal was to get past the 30-week mark,” says Cynthia.
But at 29 weeks and six days, Cynthia woke with pain near her kidneys and in her chest. Her blood pressure had risen dangerously high, and tests showed that her organs were beginning to struggle – signs that severe pre-eclampsia was progressing. The care team made the difficult but necessary decision to deliver her baby.
During an emergency Caesarean section, surgeons carefully navigated significant fluid retention to safely deliver her daughter.
Cynthia remembers feeling overwhelmed and exhausted — until she heard the sound that changed everything.
“When she was born, I heard my daughter cry right away,” Cynthia says. “That was the moment I knew she was okay.”
Before Cynthia was moved to recovery, the team brought her to see her newborn daughter, Aishnavi.
“She was still crying, very loudly,” Cynthia recalls. “I remember the nurses saying, ‘She’s so feisty.’ They told me to put my finger in her hand, and they took a picture. When she held my finger, she calmed down right away. It was a really sweet moment.”
Extending care beyond birth – for both baby and mother
Because she was born prematurely, Aishnavi was transferred to Mount Sinai’s Newton Glassman Charitable Foundation NICU, one of Canada’s leading centres for premature and low birth-weight babies.
There, neonatologists and specialized nurses provided Aishnavi with gentle breathing support while closely monitoring her development. “The NICU team was incredible,” Cynthia says. “They explained everything. They take such good care of the babies – and the parents.”
When Cynthia struggled with low milk production, she also benefited from the Rogers Hixon Ontario Human Milk Bank, which provides donated, pasteurized human breast milk for vulnerable newborns.
Two weeks later, Aishnavi was stable enough to be transferred to a NICU closer to home in Markham. And just before Christmas, she was strong enough to go home. “We surprised our family with video calls when we got home,” Cynthia says. “It was the best Christmas gift.”
A national model for complex pregnancy care and research
Cynthia’s story reflects the strength of Sinai Health’s integrated approach to maternal and fetal care.
Within the OFC, multiple specialists – including those from the Placenta Clinic, MDP program and the NICU – work together to care for patients whose pregnancies would be considered too complex for many hospitals.
The scale of the program also fuels groundbreaking research advancing pregnancy care worldwide.
“We’re known internationally for our work,” says Dr. Kingdom. “People come from around the world to see how we care for patients and how we study placental disease.”
This leadership is made possible in part by the generosity of donors.
Philanthropy supports the research, technology and collaboration that allow Sinai Health’s teams to detect complications earlier, develop innovative diagnostic tools such as PlGF testing, and deliver coordinated care for families facing high-risk pregnancies.
Cynthia’s story is a powerful reminder of what becomes possible when world-leading expertise, advanced diagnostics and compassionate care come together in one place.
And with the continued partnership of donors, Sinai Health will keep advancing the innovations that give families facing high-risk pregnancies the best possible chance for healthy beginnings.
For patients like Cynthia, that level of coordination made all the difference.
