Fetal Surgery

Abstract

In utero fetal surgery interventions are currently considered in selected cases of congenital diaphragmatic hernia, cystic pulmonary abnormalities, amniotic band sequence, selected congenital heart abnormalities, myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and complications of twin pregnancy. Randomized controlled trials have demonstrated an advantage for open fetal surgery of myelomeningocele and for fetoscopic selective laser coagulation of placental vessels in twin-to-twin transfusion syndrome. The evidence for other fetal surgery interventions, such as tracheal occlusion in congenital diaphragmatic hernia, excision of lung lesions, fetal balloon cardiac valvuloplasty, and vesicoamniotic shunting for obstructive uropathy, is more limited. Conditions amenable to intrauterine surgical treatment are rare; the mother may consider termination of pregnancy as an option for many of them; treatment can be lifesaving but in itself carries risks to both the infant (preterm premature rupture of the membranes, preterm delivery) and the mother. This makes conducting prospective or randomized trials difficult and explains the relative lack of good-quality evidence in this field. Moreover, there is scanty information on long-term outcomes. It is recommended that fetal surgery procedures be performed in centers with extensive facilities and expertise. The aims of this review were to describe the main fetal surgery procedures and their evidence-based results and to provide generalist obstetricians with an overview of current indications for fetal surgery.

Amniotic fluid transcriptomics reflects novel disease mechanisms in fetuses with myelomeningocele

“…Surprisingly, this study also identified novel genes and pathways differentially-regulated in fetuses with myelomeningocele that involve multiple distinct steps of spinal and neural development beyond neurulation processes, such as spinal cord ventral-dorsal axis development ( Wnt1 , Wnt5A , SKI, GPR37 29,30 ), neuronal differentiation, axonal development ( Wnt5A, ITPR1, PLCB3, PLCE1, ACAP1, SEMA5A , and DRAXIN 29,30 ), dorsal root ganglion development ( SEMA5A, NEUROD , and ZEB1 31 ), Schwann cell development, motor neuron survival, synapse formation and neuronal injury and repair (Table 3). Disturbances in formation of the cortico-spinal tract may explain how progressive motor impairment occurs in myelomeningocele.…”

Indications and methods for intrauterine intervention in the surgical correction of cardiac malformations

“…Эту проблему частично решили немецкие врачи из Медицинского университета Бонна: они предложили закачивать в околоплодную жидкость углекислый газ, безвредный для плода. Благодаря такому подходу отпадает необходимость в замене околоплодных вод [35,95]. Современные методы визуализации также способны в полной мере обеспечить полный обзор для хирурга.…”