Management of the Fetus With a Correctable Congenital Defect

Harrison, Michael R.

doi:10.1001/jama.1981.03320070058030

Cited by 146 publications

(21 citation statements)

References 18 publications

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“…However, the morbidity and mortality associated with such in utero operative correctio is a major concern (17)(18)(19)(20)(21)(22). Precise monitoring of maternal and fetal pressures is an important element in reducing operative risks associated with fetal corrective surgery lessen the risks of fetal surgery, one must be familiar not only with the fetal vascular anatomy, but also with the pressure limitations of the fetal cardiovascular system (23, Results of this study give a better understanding of the fragility and pressure ons of the fetal cardiovascular system (25)(26)(27). Minimal injection pressure of 1 mmHg resulted in minimal arterial visualization.…”

Section: Resultsmentioning

confidence: 99%

The use of pressure monitoring to standardize fetal arterial visualization

Shemshadi¹,

Rohrich²

1996

CAN J PLAST SURG

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H Shemshadi, RJ Rohrich, L Li, JB Robinson Jr. The use of pressure monitoring to standardize fetal arterial visualization. Can J Plast Surg 1996;4(3):161-164. The application of a new x-ray opaque postmortem perfusion system for the visualization of vascular structures in fetal models is presented. This new system allows pig fetus perfusion to be performed at pressures of less than 30 mmHg. At higher pressures, extravasations were observed in known weak spots in the fetal vasculature, and multiple perfusions at the same pressure exhibited similar patterns of extravasation (demonstrated at all pressures studied). Therefore this technique is controllable and predictable. It will allow determination of fetal vascular malformations which have been implicated as causes of many birth defects. Key Words: Anatomy, Birth detects, Fetus, Perfusion, VasculatureRecours à la surveillance de la tension pour normaliser la visualisation artérielle foetale RÉSUMÉ : L'application d'un nouveau système de perfusion post-mortem radio-opaque pour la visualisation des structures vasculaires dans des modèles foetaux est présentée ici. Le nouveau système permet d'effectuer des perfusions chez des porcelets à des pressions de moins de 30 mm Hg. À des pressions plus élevées, on observait de l'extravasation en certains points faibles connus de l'appareil vasculaire foetal et les multiples perfusions à la même pression présentaient des modes similaires d'extravasation (démontrés à toutes les pressions étudiées). Par conséquent, cette technique peut être contrôlée et prévisible. Elle permet la détermination des malformations vasculaires foetales incriminées dans de nombreuses anomalies congénitales.Fetal anatomical vasculature has been extensively studied with respect to the differences in developmental stages (1), patterns of branches, number of branches and anatomical weak points (2). With the recent advances in fetal reconstructive surgery (3), one must not only have basic knowledge of fetal anatomy but must also correlate such knowledge with the physiological changes and pressure tolerances of the fetal vascular system before performing a surgical procedure aimed at correcting an intrauterine anomaly.This study attempted to standardize a method of fetal arterial vascularization at different perfusion pressures and observe any vascular extravasations that may have been caused by increases in perfusion pressure and that are not present in the intact fetus, and to visualize what points of the fetal vascular anatomy are most susceptible to this CAN

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Section: Resultsmentioning

confidence: 99%

The use of pressure monitoring to standardize fetal arterial visualization

Shemshadi¹,

Rohrich²

1996

CAN J PLAST SURG

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“…[3][4][5][6][7][8] Persistent bilateral ureteral obstruction in the fetal animal models does contribute to significant renal dysfunction. The aberration in renal function may be reversible if the obstruction is relieved.…”

Section: Discussionmentioning

confidence: 99%

Fetal Surgery for Posterior Urethral Valves: Long-Term Postnatal Outcomes

2001

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ABSTRACT. Objective. Fetal intervention for obstructive uropathy was first performed at the University of California, San Francisco in 1981. Indications for treatment were bilateral hydronephrosis with oligohydramnios. Preintervention criteria included fetal urinary electrolytes with ␤-microglobulin levels, karyotyping, and detailed sonography specifically looking for renal cortical cysts. We reviewed the outcomes of children who underwent fetal intervention with specific long-term follow-up in patients who were found postnatally to have posterior urethral valves.

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“…The centers that have recently published most in this field have all been very honest about their results, plans and reservations about the pro cedures they have carried out [23][24][25][28][29][30][31]. In general, the results achieved so far in treat ing hydrocephalus and obstructive uropathy are very similar to the results achieved in fetal transfusions 3 years after that technique was introduced.…”

Section: The Presentmentioning

confidence: 99%

Fetal Surgery: It Has a Past, Has It a Future?

Pringle

1986

Fetal Diagn Ther

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The past history of fetal surgery is briefly reviewed. The current controversies revolving around the fetal treatment of hydrocephalus and obstructive uropathies (posterior urethral valves, prune belly syndrome, hydronephrosis) are compared and contrasted with the remarkably similar controversies that raged when fetal transfusions were first introduced. The future of fetal surgery is discussed in the light of the ethical issues raised by the prospect of fetal surgery and the rather disturbing medicolegal climate. There are already important legal precedents which will affect the field of fetal surgery. The strong opinion is expressed that fetal surgery must only remain an option offered to the mother and never forced upon her.

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Management of the Fetus With a Correctable Congenital Defect

Cited by 146 publications

References 18 publications

The use of pressure monitoring to standardize fetal arterial visualization

The use of pressure monitoring to standardize fetal arterial visualization

Fetal Surgery for Posterior Urethral Valves: Long-Term Postnatal Outcomes

Fetal Surgery: It Has a Past, Has It a Future?

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