Prospects for fetal surgery

Adzick, N. Scott

doi:10.1016/j.earlhumdev.2013.09.010

Cited by 36 publications

(28 citation statements)

References 25 publications

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“…Fetal surgery for a variety of congenital malformations is currently possible and may be advantageous over postnatal treatment for some prenatally diagnosed birth defects [1]. Techniques for safe access through opening of the gravid uterus and direct operation on the human fetus have been developed [2].…”

Section: Introductionmentioning

confidence: 99%

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

Rychik¹,

Cohen

Tran

et al. 2014

Fetal Diagn Ther

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Introduction: Fetal surgery for myelomeningocele (MMC) results in better outcomes compared to postnatal treatment. However, risks are present. We describe our experience with intraoperative fetal echocardiography during repair of MMC and report on the management of serious cardiovascular events. Material and Methods: The subjects included fetuses with intent to repair MMC from January 2011 to February 2014. The protocol involved continuous echocardiography in a looping, sequential manner of systolic function, heart rate and tricuspid and mitral valve regurgitation. Results: A total of 101 cases intended fetal MMC repair; 100 completed surgery. Intraoperative ventricular dysfunction was present in 60% (20 mild, 25 moderate, 15 severe). Heart rate <100 bpm was noted in 11 cases. Tricuspid valve regurgitation was present in 35% (26 mild, 7 moderate, 2 severe); mitral valve regurgitation was present in 19% (15 mild, 4 moderate). Serious cardiovascular events were experienced in 7 cases, which affected the conduct of surgery and/or outcome. In 4 of these, medications were given via the umbilical vein and external cardiac compressions were performed. Fetal echocardiography was used to gauge the efficacy of compressions and to guide resuscitation. Discussion: Cardiovascular compromise is common during fetal surgery for MMC. Intraoperative fetal echocardiography is recommended as a growing number of centers contemplate offering this form of novel, but potentially risky, therapy.

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Section: Introductionmentioning

confidence: 99%

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

Rychik¹,

Cohen

Tran

et al. 2014

Fetal Diagn Ther

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“…Major exclusion criteria were kyphosis > 30°, oligohydramnion, placenta previa, high risk of preterm labor (short cervix ≤ 20 mm, previous preterm labours), previous hysterotomies, contraindication for epidural analgesia, maternal diseases like diabetes mellitus type 1, hypertension, obesity (BMI > 35), thrombophilia, and infectious diseases (TORCH, abnormal bacterial flora in the cervical canal, respiratory tract infection, urinary tract infection, chronical infectious diseases of urinary tract) [13][14][15].…”

Section: Patients Qualification In Polish Fsc Bytommentioning

confidence: 99%

Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

et al. 2020

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Objectives:We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and fetal/neonatal outcomes. Material and methods:We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for the early period (2005)(2006)(2007)(2008)(2009)(2010)(2011) year; previous -PFSC, n = 46) and current period (2012)(2013)(2014)(2015) year; current -CFSC, n = 74) to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients). Results:The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9% in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC -90.3% and PFSC -82.1%. Conclusions:The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

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“…This obstruction results in loss of extra-axial fluid volume between the fetal cortex and the skull. Open fetal surgery leads to reopening of the fourth ventricle and the extra-axial fluid spaces and normalization of the HC biometry [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Small Biparietal Diameter and Head Circumference Are Part of the Phenotype instead of Independent Prognostic Markers in Fetuses with Spinal Dysraphism

Cuppen

Bruijn²,

Geerdink³

et al. 2014

Fetal Diagn Ther

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Objective: The aim of this retrospective study was to assess the fetal biparietal diameter (BPD) and head circumference (HC) in the second trimester of pregnancy in fetuses with open spinal dysraphism. Methods: BPD and HC were measured at 16-26 weeks in 74 fetuses with open spinal dysraphism and compared with reference values. Results: BPD was smaller in fetuses with open spinal dysraphism. Of all cases with open spinal dysraphism, 62.2% had a BPD <3rd percentile and 79.7% had a BPD <10th percentile. Of all patients, 54.1% had an HC <3rd percentile and 74.3% had an HC <10th percentile. Conclusion: Almost all fetuses with open neural tube defects have a smaller BPD and HC at 16-26 weeks compared with reference values, which implicates that this is part of the phenotype of children with open spinal dysraphism instead of an independent prognostic marker for a poor cognitive outcome.

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Prospects for fetal surgery

Cited by 36 publications

References 25 publications

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair

Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Small Biparietal Diameter and Head Circumference Are Part of the Phenotype instead of Independent Prognostic Markers in Fetuses with Spinal Dysraphism

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