Vasopressin in Oligohydramnios-Induced Lung Hypoplasia

Ct, Shen; Ac, Moessinger; Gt, Kiu; Ls, James

doi:10.1203/00006450-199012000-00010

Cited by 1 publication

(1 citation statement)

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“…39 Since most invasive procedures are performed in the 2nd trimester, iPPROM usually occurs at an early gestational age. 47 There was no difference in degree of pulmonary hypoplasia in heterozygote or homozygote AVP rats. 40 As such, sPPROM before 25 weeks' gestation with severe oligohydramnios for more than 14 days has a predicted perinatal mortality of over 90 per cent.…”

Section: Preterm Prelabour Rupture Of Membranesmentioning

confidence: 83%

Fetoscopic Surgery for in-Utero Management of Congenital Diaphragmatic Hernia

Nelson

Cameron

Deprest³

2006

Fet. Matern. Med. Rev.

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INTRODUCTIONUntil recently two possibilities were available to the expectant parents of a fetus diagnosed with a congenital diaphragmatic hernia: termination of pregnancy or continuation of the pregnancy until term with a potential change in the place of delivery. Open fetal surgery has been used to treat a growing number of congenital malformations with life-threatening or highly morbid consequences including congenital diaphragmatic hernia. 1 However, its effectiveness is limited by the occurrence of preterm labour, chorioamniotic membrane separation, preterm prelabour rupture of the membranes and altered fetal homeostasis. 2 These problems were the impetus for the development of minimal access fetal surgery. Developments in endoscopic surgical technology over the past three decades have provided the opportunity to develop techniques adapted for prenatal fetal intervention. 3 RATIONALE FOR FETOSCOPIC SURGERYExperimental studies on the effect of minimal access fetal surgery suggest that it reduces preterm labour and achieves better maintenance of fetal and maternal homeostasis. 4 With respect to preterm labour fetoscopic access in mid-trimester Rhesus monkeys did not result in any significant uterine contractions by 24 hours post-operatively. 5 Subsequent recordings of myometrial activity were repeated during the third trimester, and no premature contractions were noted. In contrast, Luks and colleagues studying third trimester sheep found that uterine contractions were present 52% of the time after maternal laparotomy irrespective of whether a hysterotomy or fetoscopic access using three ports was performed. 6 These myometrial contractions were noted in response to access only, as no fetal manipulation was undertaken. The primate uterus resembles the human uterus much more closely than the ovine and is generally accepted as a good model for studies into human parturition, questioning the application of ovine myometrial activity studies to the human situation.With respect to maternal-fetal homeostasis, Luks demonstrated in the same study a significant 27% reduction in uterine blood flow and utero-placental oxygen delivery with hysterotomy creation, whereas endoscopic access had no effect. 6 When uterine artery flow and thus oxygen delivery is reduced to 70% of control, there is a shift in fetal blood flow distribution, a decrease in fetal pH and an increase in serum lactate. 7 It is likely that oxygen delivery would be further impaired during open fetal surgery, by manipulation of the uterus, active pressure on uterine vessels and traction or compression of the umbilical cord. Therefore the endoscopic approach, which does not alter uteroplacental oxygen delivery, would be preferable. Clinical experience with human fetoscopic surgery reflects this experimental work. Fetoscopic intervention produces less preterm labour with less use of tocolytics, decreased maternal hospital stay and decreased maternal complications related to tocolysis. 8

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Section: Preterm Prelabour Rupture Of Membranesmentioning

confidence: 83%