China
Africa
Explore chapters and articles related to this topic
Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
When first developed in the 1970s, fetoscopy functioned as a diagnostic tool, but it has since become a tool for minimally invasive fetal interventions with the development of more advanced camera equipment and endoscopic devices. Fetoscopy has similar complications to open fetal surgery, including bleeding, preterm premature rupture of membranes, preterm labor with delivery <32 weeks, chorioamniotic separation, and chorioamnionitis. The risk of fetoscopic complications correlates with the size of the fetoscope, the number of trocar sites, and the length of the procedure. For simple procedures, the risk of preterm labor is lower than open fetal surgery. The procedure can generally be performed percutaneously under local or regional anesthesia. However, any procedure that would potentially cause fetal pain should include intramuscular injection of an opioid and a paralytic agent for fetal anesthesia.
Prenatal Diagnosis and Early Treatment of Immunodeficiencies in Man
Published in Gérard Chaouat, The Immunology of the Fetus, 2020
Catherine Royo, Jean-Louis Touraine
The syndrome, first described by Durandy et al.,38 affects patients prone to recurrent pyogenic infections, neutropenia, thrombocytopenia, and pigmentation abnormality. Death occurs during childhood. Abnormal T-lymphocyte functions resulting in a humoral deficiency and impaired granulocyte metabolic functions are the immune features of the disease. Polymorphonuclear cells have a normal morphology, and the disease is inherited in an autosomal recessive form. The diagnosis of the disease could be excluded in a fetus at risk by microscopic examination of skin and hair obtained by fetoscopy.39
Assessment of Fetal Well-Being During the Second Half of Pregnancy
Published in Miriam Katz, Israel Meizner, Vaclav Insler, Fetal Well-Being, 2019
Miriam Katz, Israel Meizner, Vaclav Insler
PUBS for obtaining fetal blood samples is now performed in many centers. The technique has great potential. It can be used as early as at weeks 16 to 17 of gestation and through the remainder of pregnancy. Fetal blood sampling in the second or third trimester offers new and more accurate means of prenatal diagnosis. The indications for the procedure are extensive and include all previous indications for fetoscopy. Considering the fact that PUBS enables obtaining fetal blood samples for a variety of tests and analyses, one may anticipate that in the future this technique will be applied in a wide spectrum of diagnostic and therapeutic indications.
Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond
Published in Expert Review of Hematology, 2020
Marjolijn S. Spruijt, Enrico Lopriore, Sylke J. Steggerda, Femke Slaghekke, Jeanine M.M. Van Klink
Fetoscopic laser surgery is now considered the best available treatment for advanced stages (Quintero stage ≥ 2) TTTS [24,27–30]. The technique using a fetoscopic laser to disrupt blood flow through the vascular communications was developed in the 1980s and it soon became clear that this therapy would become a ‘game changer’ in the field of TTTS [31]. In contrast to serial amnioreduction, laser surgery is the only causative treatment, aiming to stop the intertwin fetal transfusion process. The first laser procedures were performed under general anesthesia and required laparotomy and hysterotomy for introduction of the endoscope, followed by laser photocoagulation. Since then, many developments have taken place. Laser technique has evolved from so-called ‘non-selective’ ablation of all vessels at the chorionic surface close to the intertwin membrane, to the selective technique in which the goal is to only coagulate anastomotic vessels at the vascular equator [29,32–35]. In TTTS, the vascular equator is at some distance from the intertwin membrane due to the discordant amniotic fluid volumes between the twins. Laser surgery in TTTS is now minimally invasive, usually with local or regional anesthesia and percutaneous fetoscopy under continuous ultrasound guidance, thereby minimizing the risk of maternal complications [36]. Whether laser treatment is the best option for stage I TTTS is uncertain, as different groups have reported different results [37]. A multicenter RCT of stage I disease has recently been carried out and the results will hopefully answer this important question.
Chorioangiomas in pregnancy – case report
Published in Journal of Obstetrics and Gynaecology, 2019
Manolis Nikolopoulos, Chineze Otigbah, Madhavi Kalidindi
The pathophysiology of maternal and foetal complications is not well understood. The theories for polyhydramnios include an increased urine production due to foetal hyperdynamic circulation (Wu and Hu 2016), transudation of fluid caused by a mechanical obstruction of blood flow by the tumour near the cord insertion and the functional insufficiency of the placenta secondary to bypassing foetal circulation via the arteriovenous shunting mechanism in the tumour vascular bed. Fetal cardiomegaly and congestive heart failure is also a potential complication and is thought to occur secondary to high cardiac output from arteriovenous shunting, or chronic hypoxia from unoxygenated blood that bypasses maternal circulation through the tumour vascular bed (Kirkpatrick et al. 2007). Growth restriction, uteroplacental insufficiency and foetal distress are also potential outcomes. Fetal non-immune hydrops is an extremely rare complication but can be caused by all of the above factors, including anaemia (Wu and Hu 2016). Around 50% of large chorioangioma cases develop foetal and maternal complications which require either elective delivery or intervention for tumour-related effects (Garcia-Diaz et al. 2012). In case of extreme prematurity, the following techniques have been described: amnioreduction in cases with symptomatic polyhydramnios, intrauterine transfusion if there is an ultrasound evidence of foetal anaemia and though rare, platelet transfusion may also be necessary. Ultrasound-guided interstitial laser therapy, in utero endoscopic devascularisation with use of suture ligation or bipolar cautery of the feeding vessels via fetoscopy, microcoil embolisation and alcohol injection (Acharya 2004; Garcia-Diaz et al. 2012).
TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery
Published in Fetal and Pediatric Pathology, 2018
Gabriele Tonni, Gianpaolo Grisolia, Paolo Zampriolo, Federico Prefumo, Anna Fichera, Paola Bonasoni, Mathilde Lefebvre, Suonavy Khung-Savatovsky, Fabien Guimiot, Jonathan Rosenblatt, Edward Araujo Júnior
A 29-year-old G1P1 was diagnosed at 11 + 2 weeks of gestation as MC/MA twin pregnancy with one normal twin (A, pump twin) with a CRL (crown-rump length) of 61 mm and a mass (B, acardiac) with a CRL of 30 mm without cardiac activity. Follow-up scan at 14 + 1 weeks confirmed a normal fetus with a CRL of 84 mm, normal heart and an acardiac mass of 44 mm CRL consistent with a reversed arterial perfusion (TRAP) sequence (Fig. 5). Ultrasound examination performed at 15 weeks showed entanglement of cords (Fig. 6). The mother was counseled about possible therapeutic interventions and opted to undergo laser-umbilical cord occlusion (L-UCO) that was planned at 17 + 5 weeks. Placenta was anterior. The result of the karyotype performed at the time of fetoscopy was 46,XX. Fetoscopic L-UCO was performed according to previous publised technique using a single-entry 2-mm fetoscope technique [6]. The estimated fetal weight (EFW) was 217 ± 27 g (34 centile) at the time of procedure. Both umbilical cords were entangled from the placental insertions to a very short distance (around one centimeter) before entering the acardiac mass. The umbilical cord of the acardiac mass was photocoagulated near its abdominal insertion resulting in the absence of Doppler flow visible towards the mass. The follow-up scan performed the following day showed an absent Doppler flow in the acardiac mass and a normal cardiac activity within the normal twin. At 21 + 2 weeks, the mother presented with vaginal bleeding associated with uterine contractions requiring hospitalization and tocolysis. Premature rupture of the membranes occured at 21 + 5 weeks with anhydramnios and maternal C reactive protein level was 70 mg/L. IUFD was diagnosed at 21 + 6 weeks. Evacuation of the products of conception was achieved by oral administration of Mifegyne™.