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Obstetrics and gynaecology
Published in David A Lisle, Imaging for Students, 2012
Amniotic fluid volume is assessed. Low amniotic fluid volume or oligohydramnios may be caused by intrauterine growth retardation secondary to placental insufficiency, chromosomal disorders, congenital infection and severe maternal systemic illness. Severe oligohydramnios may also indicate the presence of renal agenesis or obstruction of the fetal urinary tract. Common causes of increased amniotic fluid volume or polyhydramnios include maternal diabetes, multiple pregnancy, neural tube defect, fetal hydrops, and any disorder with impaired fetal swallowing such as oesophageal atresia. In many cases, polyhydramnios is idiopathic, with no underlying cause found.
Fetal surgery: how recent technological advancements are extending its applications
Published in Expert Review of Medical Devices, 2019
Recently, fetoscopy has also been applied to the in utero repair of spina bifida (SB). Spina bifida, usually myelomeningocele (MMC), is a congenital defect, in which the spine fails to fully close around the spinal cord [13]. As a result, the spinal cord protrudes through the opening of the spinal column and may be enclosed in a fluid-filled sac. MMC is associated with significant life-long disabilities from complications such as hydrocephalus, motor and cognitive defects, bowel and bladder dysfunction, and social and emotional challenges. Open MMC repair involves a combination of general and epidural anesthesia as well as fetal anesthesia. In 2011, a prospective multicenter randomized controlled trial known as the Management of Myelomeningocele Study (MOMS) demonstrated a decreased need for ventriculoperitoneal shunting, reversal of hindbrain herniation, and improved neurologic function in the prenatal repair group compared to the postnatal repair group [14]. Due to its efficacy, fetal MMC closure has become a standard of care option for prenatally diagnosed spina bifida. However, the procedure comes with several tradeoffs including higher rates of obstetrical complications such as oligohydramnios, chorioamniotic membrane separation, placental abruption, premature rupture of membranes, preterm delivery, and uterine scar dehiscence. In order to reduce the rate of these complications associated with open fetal MMC repair, a fetoscopic approach has been developed. Initial studies have demonstrated that fetoscopic MMC repair is associated with similar results compared to the open in utero repair (MOMS trial) with less complications to the mothers (possibility of vaginal deliveries and reduced prematurity) [13]. Because of this technique’s development, some groups are now attempting the two-layer closure with the fetoscopic approach [13]. However, further studies are still necessary to compare long-term outcomes after fetoscopic MMC repair with open MMC repair.