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Ruegg L, Vonzun L, Latal B, Moehrlen U, Mazzone L, Meuli M, Krähenmann F, Ochsenbein-Kölble N. Impact on postoperative, neonatal and 2-year neurodevelopmental outcomes of UA-AREDF during and after fetal spina bifida repair. Ultrasound Obstet Gynecol 2023; 61:734-739. [PMID: 36357943 DOI: 10.1002/uog.26118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Absent or reversed end-diastolic flow (AREDF) in the umbilical artery (UA) on Doppler is a known phenomenon during fetal interventions, such as fetal open spina bifida (OSB) repair. We aimed to evaluate the clinical importance of these Doppler findings by investigating the impact of UA-AREDF on postoperative, neonatal and 2-year neurodevelopmental outcomes. METHODS This was a prospective study of pregnancies undergoing fetal OSB repair at the Zurich Center for Fetal Diagnosis and Therapy between 2010 and 2019. The group with UA-AREDF during or immediately after the intervention was compared to the group with normal UA Doppler. Primary endpoint was the FIGO scores of cardiotocography (CTG) 1, 2 and 6 h postoperatively and on day 1 after surgery. Secondary endpoints were the neonatal parameters and 2-year neurodevelopmental outcome assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Data of 130 patients were analyzed. None of the fetuses had UA-AREDF before OSB repair. Normal UA Doppler was observed in 107 (82%) patients and UA-AREDF was observed in 23 (18%) during or immediately after OSB surgery. UA-AREDF was more often observed after version of the fetus (P = 0.045). Seventeen (13%) cases had absent end-diastolic flow (UA-AEDF) and six (5%) cases had reversed end-diastolic flow (UA-REDF). UA-AREDF disappeared in all 23 cases within the first day after OSB surgery. One-third of all CTGs were restricted in oscillation after surgery, but no significant difference in CTG 1, 2 and 6 h postoperatively or on the first postoperative day was found between the UA-AREDF and normal-Doppler groups (P > 0.05). Gestational age at delivery, UA pH, 5-min Apgar score and birth weight were comparable between the two groups, and there was no difference in the 2-year neurodevelopmental outcome (P > 0.05). The neonatal and 2-year neurodevelopmental outcomes also did not differ significantly between the UA-REDF and UA-AEDF groups. CONCLUSIONS Postoperative CTG abnormalities occur and recover at a similar rate in fetuses with transitory UA-AREDF and those with normal Doppler during fetal OSB repair. UA-AREDF during fetal OSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcomes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Ruegg
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - L Vonzun
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - B Latal
- University of Zurich, Zurich, Switzerland
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Moehrlen
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - L Mazzone
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - F Krähenmann
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
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Gonser M, Vonzun L, Ochsenbein-Kölble N. Association of ophthalmic artery Doppler and maternal cardiac changes in preclinical stage of pre-eclampsia: hemodynamic relationship. Ultrasound Obstet Gynecol 2022; 59:402-404. [PMID: 34985792 DOI: 10.1002/uog.24845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M Gonser
- Prenatal Medicine and Sonography, Wiesbaden, Germany
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
| | - L Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Gonser M, Vonzun L, Kandler L, Ochsenbein-Kölble N. Fetal circulatory redistribution during open spina bifida repair: can loss or reversal of end-diastolic umbilical artery flow be avoided? Ultrasound Obstet Gynecol 2022; 59:130-131. [PMID: 34985819 DOI: 10.1002/uog.24822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M Gonser
- Prenatal Medicine & Sonography, Wiesbaden, Germany
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
| | - L Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - L Kandler
- University of Zurich, Zurich, Switzerland
- Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Gonser M, Vonzun L, Ochsenbein-Kölble N. Ophthalmic artery Doppler in prediction of pre-eclampsia: insights from hemodynamic considerations. Ultrasound Obstet Gynecol 2021; 58:145-147. [PMID: 34028931 DOI: 10.1002/uog.23665] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Gonser
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
| | - L Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Vonzun L, Kahr MK, Noll F, Mazzone L, Moehrlen U, Meuli M, Hüsler M, Krähenmann F, Zimmermann R, Ochsenbein-Kölble N. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort. BJOG 2020; 128:1184-1191. [PMID: 33152167 DOI: 10.1111/1471-0528.16593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN A prospective cohort study. SETTING Single centre. POPULATION Mothers and fetuses after fMMC repair. METHODS Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES Systematic classification of maternal and fetal complications following fMMC repair. RESULTS Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair.
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Affiliation(s)
- L Vonzun
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - M K Kahr
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - F Noll
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - L Mazzone
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Moehrlen
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Hüsler
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - F Krähenmann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - R Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
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Vonzun L, Mazzone L, Moehrlen U, Meuli M, Krähenmann F, Zimmermann R, Ochsenbein-Kölble N, Horst M. Systematic sonographic bladder volume measurements at evaluation and directly after fetal myelomeningocele repair – is bladder function predictable? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Vonzun
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - L Mazzone
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - U Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - M Meuli
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - F Krähenmann
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - R Zimmermann
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - N Ochsenbein-Kölble
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - M Horst
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
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Kahr M, Meuli M, Moehrlen U, Mazzone L, Winder F, Vonzun L, Krähenmann F, Hüsler M, Zimmermann R, Ochsenbein-Kölble N. Open intrauterine fetal Myelomeningocele repair: Learning curve of the surgical procedure and perinatal complications. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Kahr
- Universitätsspital Zürich, Gynäkologie und Geburtshilfe, Zürich, Schweiz
| | - M Meuli
- Kinderspital Zürich, Zürich, Schweiz
| | | | - L Mazzone
- Kinderspital Zürich, Zürich, Schweiz
| | - F Winder
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - L Vonzun
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - F Krähenmann
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - M Hüsler
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - R Zimmermann
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
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Vonzun L, Winder FM, Meuli M, Moerlen U, Mazzone L, Krähenmann F, Hüsler M, Zimmermann R, Ochsenbein-Kölble N. Hindbrain herniation, banana, and lemon sign after open fetal myelomeningocele repair – when do this signs disappear and is shunting predictable? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Vonzun
- Department of Obstetrics, University of Zurich, Zürich, Schweiz
| | - FM Winder
- Department of Obstetrics, University of Zurich, Zürich, Schweiz
| | - M Meuli
- University Children's Hospital Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - U Moerlen
- University Children's Hospital Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - L Mazzone
- University Children's Hospital Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - F Krähenmann
- Department of Obstetrics, University of Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - M Hüsler
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - R Zimmermann
- Department of Obstetrics, University of Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University of Zurich, Zürich, Schweiz
- Zurich Center for Fetal Diagnosis and Therapy, Department of Pediatric Surgery, Zürich, Schweiz
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Kahr M, Winder F, Vonzun L, Meuli M, Moehrlen U, Mazzone L, Krähenmann F, Hüsler M, Zimmermann R, Ochsenbein-Kölble N. Risk factors for preterm birth following open fetal myelomeningocele repair – results from a prospective cohort. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Kahr
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - F Winder
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - L Vonzun
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - M Meuli
- Kinderspital Zürich, Zürich, Schweiz
| | | | - L Mazzone
- Kinderspital Zürich, Zürich, Schweiz
| | - F Krähenmann
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - M Hüsler
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
| | - R Zimmermann
- Universitätsspital Zürich, Geburtshilfe, Zürich, Schweiz
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Vonzun L, Brand B, Hustinx H, Komarek A, Zimmermann R, Kimmich N. Management bei Anti-Coltona Alloimmunisierung in der Schwangerschaft: Ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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