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Richter J, Doktor F, Good H, Erdman L, Kim JK, Santos JD, Brownrigg N, Chua M, Lorenzo AJ, Rickard M, Mieghem TV, Shinar S. Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System. Eur J Pediatr Surg 2024; 34:91-96. [PMID: 37607585 DOI: 10.1055/s-0043-1772172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Neonates with lower urinary tract obstruction (LUTO) experience high morbidity and mortality associated with the development of chronic kidney disease. The prenatal detection rate for LUTO is less than 50%, with late or missed diagnosis leading to delayed management and long-term sequelae in the remainder. We aimed to explore the trends in prenatal detection and management at a high-risk fetal center and determine if similar trends of postnatal presentations were noted for the same period. METHODS Prenatal and postnatal LUTO databases from a tertiary fetal center and its associated pediatric center between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis using autocorrelation was performed to investigate time trend changes for prenatally suspected and postnatally confirmed LUTO cases. RESULTS A total of 161 fetuses with prenatally suspected LUTO were identified, including 78 terminations. No significant time trend was found when evaluating the correlation between time periods, prenatal suspicion, and postnatal confirmation of LUTO cases (Durbin-Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at initial ultrasound was earlier in terminated fetuses compared to continued (20.0 [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO suspicion remained consistently higher than postnatal presentations, the rates of postnatal presentations and terminations remained stable during the study years (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis (p = 0.1710 and 0.1921). CONCLUSION This study demonstrated that more severe cases of LUTO are referred earlier and are more likely to undergo TOP. No significant trend was detected between time and prenatally suspected or postnatally confirmed LUTO, highlighting the need for further studies to better delineate factors that can increase prenatal detection.
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Affiliation(s)
- Juliane Richter
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fabian Doktor
- Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany
| | - Hayley Good
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Erdman
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natasha Brownrigg
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Urology, St. Luke's Medical Center, Philippines
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shiri Shinar
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Monti M, Mandrile G, Piatelli G, Rossi A, Mattioli G, Moscatelli A, Pavanello M. Posthemorrhagic hydrocephalus management in patients with necrotizing enterocolitis: a monocentric experience. Childs Nerv Syst 2024; 40:471-478. [PMID: 37610694 DOI: 10.1007/s00381-023-06129-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Posthemorrhagic hydrocephalus (PHH) and necrotizing enterocolitis (NEC) are two comorbidities associated with prematurity. The management of patients with both conditions is complex and it is necessary to intercept them to avoid meningitis and multilocular hydrocephalus. METHODS In a single-center retrospective study, we analyzed 19 patients with NEC and PHH admitted from 2012 to 2022. We evaluated perinatal, imaging, and NEC-related data. We documented shunt obstruction and infection and deaths within 12 months of shunt insertion. RESULTS We evaluated 19 patients with NEC and PHH. Six cases (31.58%) were male, the median birth weight was 880 g (650-3150), and the median gestational age was 26 weeks (23-38). Transfontanellar ultrasound was performed on 18 patients (94.74%) and Levine classification system was used: 3 cases (15.79%) had a mild Levine index, 11 cases (57.89%) had moderate, and 5 cases (26.32%) were graded as severe. Magnetic resonance showed intraventricular hemorrhage in 14 cases (73.68%) and ventricular dilatation in 15 cases (78.95%). The median age at shunt insertion was 24 days (9-122) and the median length of hospital stay was 120 days (11-316). Sepsis was present in 15 cases (78.95%). NEC-related infection involved the peritoneal shunt in 4 patients and 3 of them had subclinical NEC. At the last follow-up, 6 (31.58%) patients presented with psychomotor delay. No deaths were reported. CONCLUSIONS Although recognition of subclinical NEC is challenging, the insertion of a ventriculoperitoneal shunt is not recommended in these cases and alternative treatments should be considered to reduce the risk of meningitis and shunt malfunction.
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Affiliation(s)
- Martina Monti
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- DINOGMI, University of Genoa, Genoa, Italy.
| | - Gloria Mandrile
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | | | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Pavanello
- Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Li JC, Du J, Yang ZX, Jin F, Weng JW, Qi YJ, Huang JS, Hei MY, Jiang M. [Analysis of clinical characteristics and risk factors of postoperative complications in infants with early-onset necrotizing enterocolitis after enterostomy]. Zhonghua Yi Xue Za Zhi 2024; 104:38-44. [PMID: 38178766 DOI: 10.3760/cma.j.cn112137-20230926-00577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Objective: To investigate the clinical characteristics of children with early-onset necrotizing enterocolitis (NEC) undergoing enterostomy and analyze the risk factors for postoperative complications. Methods: Retrospective analysis was conducted on the clinical data (perinatal conditions, clinical characteristics, clinical outcomes, etc.) of NEC patients who underwent enterostomy at Beijing Children's Hospital from May 2016 to May 2023. The patients were divided into two groups based on the age of onset: an early-onset enterostomy group (<14 days) and a late-onset enterostomy group (≥14 days). Furthermore, the children with NEC were categorized into complication group and non-complication group based on whether there were complications after enterostomy. The differences in clinical data between these groups were analyzed, and the clinical characteristics of children with early-onset NEC and enterostomy were summarized. Multivariate logistic regression model was employed to analyze the risk factors for postoperative complications in NEC children with enterostomy. Results: A total of 68 cases were enrolled, including 43 cases in the early-onset enterostomy group [26 males and 17 females, aged (6.5±3.0) days] and 25 cases in the late-onset enterostomy group [15 males and 10 females, aged (21.0±3.0) days]. There were 28 cases (17 males and 11 females), age [M (Q1, Q3)] 9 (5, 14) days in the complication group and 33 cases (22 males and 11 females), aged of 14 (6, 21) days in the non-complication group. Compared to the late-onset enterostomy group, the early-onset enterostomy group had significantly higher rates of intraventricular hemorrhage [30.2% (13/43) vs 8.0% (2/25)], hemodynamically significant patent ductus arteriosus [37.2% (16/43) vs 12.0% (3/25)], mechanical ventilation≥72 hours after birth [39.5% (17/43) vs 16.0% (4/25)], stage Ⅲ NEC [(69.8% (30/43) vs 40.0% (10/25)], extensive NEC [27.9% (12/43) vs 8.0% (2/25)], and short-term postoperative complications [56.8% (21/37) vs 29.2% (7/24)] (all P<0.05).Multivariate logistic regression model analysis revealed that residual length of proximal small intestine was a protective factor for postoperative complications after enterostomy in NEC infants (OR=0.764, 95%CI: 0.648-0.901, P=0.001), but stage Ⅲ NEC was a risk factor (OR=1.042, 95%CI: 1.004-5.585, P=0.017). Conclusions: The incidence of postoperative complications is high, and the prognosis is poor in children with early-onset NEC enterostomy. The residual length of proximal enterostomy is a protective factor for postoperative complications of NEC enterostomy, but stage Ⅲ NEC is a risk factor.
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Affiliation(s)
- J C Li
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - J Du
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - Z X Yang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - F Jin
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - J W Weng
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - Y J Qi
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - J S Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - M Y Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - M Jiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
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Matabele MN, Cheng C, Venkatesh M, Barr S, Ellefson J, Beninati M, Lobeck IN, Puricelli MD. Perinatal airway management in neonatal goiter: A healthcare cost and utilization project (HCUP) kids' inpatient database analysis. Int J Pediatr Otorhinolaryngol 2023; 175:111767. [PMID: 37931498 PMCID: PMC10841841 DOI: 10.1016/j.ijporl.2023.111767] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Fetal goiter is a rare congenital disorder that can present with life-threatening neonatal airway obstruction. Lifesaving and function-preserving airway management strategies are available, but routine delivery affords a limited window for intervention. Accordingly, fetal goiter is reported among the most common indications for ex-utero intrapartum treatment (EXIT). While EXIT prolongs the window for airway intervention to benefit the neonate, it elevates the risk to the pregnant person and requires extensive resources; therefore, data to guide ideal treatment selection are essential. This study aims to compare perinatal airway interventions between individuals with a birth hospitalization discharge diagnosis (BHDD) of goiter and the general population. MATERIALS AND METHODS Individuals with and without BHDD of goiter were identified in the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database from 2000 to 2019. The frequency of airway interventions on day of life (DOL) 0 or 1 were compared using the Rao-Scott chi-square test. Additionally, gestational age, type of intervention, complications, mortality, birth weight, and length of stay were examined for the goiter cohort. RESULTS Two-hundred eighty-seven weighted cases of goiter were identified in the study period. The population was 61 % male, 55 % White, and median birthweight was 3.3 kg. The median length of stay was 4.3 days, and average total charges were $42,332. Airway intervention on DOL 0 or 1 was performed in 16.9 % of individuals with goiter compared to 1.6 % in neonates without goiter (p < 0.001). Interventions in the goiter cohort included endotracheal intubation in 16 % of cases, laryngoscopy/bronchoscopy in 1-5% of cases, and tracheostomy in <1 % of cases. Fewer than 1 % of individuals undergoing intubation additionally had mass decompression/resection on DOL 0 or 1. No neonates received extracorporeal membrane oxygenation cannulation or cardiopulmonary resuscitation. Hypoxic encephalopathy occurred in <1 % of cases, among which endotracheal intubation was the only airway intervention performed. There were no mortalities among neonates with goiter. CONCLUSION Individuals with BHDD of goiter receive significantly higher rates of perinatal airway intervention. In most cases, endoscopic interventions alone were sufficient to avoid hypoxic neurological complications. These findings contribute to data to aid in clinical counseling and empower patients to make informed decisions according to their values and treatment goals.
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Affiliation(s)
- Maya N Matabele
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christie Cheng
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Manasa Venkatesh
- Department of Surgery Statistical Analysis and Research Programming Core, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Samantha Barr
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Johanna Ellefson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Beninati
- Division of Maternal-Fetal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Inna N Lobeck
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael D Puricelli
- Division of Otolaryngology Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Safa N, Yanchar N, Puligandla P, Sewitch M, Baird R, Beaunoyer M, Campbell N, Chadha R, Griffiths C, Jones S, Kaur M, Le-Nguyen A, Nasr A, Piché N, Piper H, Prasil P, Romao RLP, VanHouwelingen L, Wales P, Guadagno E, Emil S. Treatment and Outcomes of Congenital Ovarian Cysts A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). Ann Surg 2023; 277:e1130-e1137. [PMID: 35166261 PMCID: PMC10082055 DOI: 10.1097/sla.0000000000005409] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts. SUMMARY BACKGROUND DATA Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known. METHODS Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter. RESULTS The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131). CONCLUSIONS Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
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Affiliation(s)
- Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Natalie Yanchar
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maida Sewitch
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Robert Baird
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Beaunoyer
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niamh Campbell
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Rati Chadha
- Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Griffiths
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Jones
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manvinder Kaur
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Annie Le-Nguyen
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Nelson Piché
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Piper
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascale Prasil
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Paul Wales
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Bruni V, Spoleti CB, La Barbera A, Dattilo V, Colao E, Votino C, Bellacchio E, Perrotti N, Giglio S, Iuliano R. A Novel Splicing Variant of COL2A1 in a Fetus with Achondrogenesis Type II: Interpretation of Pathogenicity of In-Frame Deletions. Genes (Basel) 2021; 12:genes12091395. [PMID: 34573377 PMCID: PMC8467821 DOI: 10.3390/genes12091395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023] Open
Abstract
Achondrogenesis type II (ACG2) is a lethal skeletal dysplasia caused by dominant pathogenic variants in COL2A1. Most of the variants found in patients with ACG2 affect the glycine residue included in the Gly-X-Y tripeptide repeat that characterizes the type II collagen helix. In this study, we reported a case of a novel splicing variant of COL2A1 in a fetus with ACG2. An NGS analysis of fetal DNA revealed a heterozygous variant c.1267-2_1269del located in intron 20/exon 21. The variant occurred de novo since it was not detected in DNA from the blood samples of parents. We generated an appropriate minigene construct to study the effect of the variant detected. The minigene expression resulted in the synthesis of a COL2A1 messenger RNA lacking exon 21, which generated a predicted in-frame deleted protein. Usually, in-frame deletion variants of COL2A1 cause a phenotype such as Kniest dysplasia, which is milder than ACG2. Therefore, we propose that the size and position of an in-frame deletion in COL2A1 may be relevant in determining the phenotype of skeletal dysplasia.
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Affiliation(s)
- Valentina Bruni
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Cristina Barbara Spoleti
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Andrea La Barbera
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy;
| | - Vincenzo Dattilo
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Emma Colao
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | | | - Emanuele Bellacchio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Nicola Perrotti
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Sabrina Giglio
- Unit of Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Rodolfo Iuliano
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
- Correspondence: ; Tel.: +39-0961-3695182
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Donepudi R, Shamshirsaz AA, Espinoza J, Sanz-Cortes M, Belfortv MA, Nassr AA. Peritoneal-amniotic shunt in management of urinary ascites complicating fetal lower urinary tract obstruction. Ultrasound Obstet Gynecol 2021; 58:320-322. [PMID: 32770819 DOI: 10.1002/uog.22170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Donepudi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz-Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | | | - A A Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
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Guilbaud L, Maurice P, Lallemant P, De Saint-Denis T, Maisonneuve E, Dhombres F, Friszer S, Di Rocco F, Garel C, Moutard ML, Lachtar MA, Rigouzzo A, Forin V, Zérah M, Jouannic JM. Open fetal surgery for myelomeningocele repair in France. J Gynecol Obstet Hum Reprod 2021; 50:102155. [PMID: 33915336 DOI: 10.1016/j.jogoh.2021.102155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 04/23/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Open fetal myelomeningocele (MMC) surgery is currently the standard of care option for prenatal MMC repair. We described the population referred to our center and reviewed outcome after open fetal MMC repair. MATERIAL AND METHODS All patients referred to our center for MMC were reviewed from July 2014 to June 2020. For all the patients who underwent fetal MMC repair, surgical details, maternal characteristics and data from the neonatal to the three-years-old evaluations were collected. RESULTS Among the 126 patients referred to our center, 49.2% were eligible and 27.4% (n = 17) of them underwent fetal MMC repair. Average gestational age at fetal surgery was 24+6 weeks. There was no case of fetal complication and the only maternal complication was one case of transfusion. We recorded 70% of premature rupture of membranes and 47% of premature labor. Average gestational age at delivery was 34+2 weeks and no patient delivered before 30 weeks. There was no case of uterine scar dehiscence or maternal complication during cesarean section. After birth, 59% of the children had a hindbrain herniation reversal. At 1-year-old, 42% were assigned a functional level of one or more better than expected according to the prenatal anatomic level and 25% required a ventriculoperitoneal shunt. At 3-year-old, all the children attended school and 75% were able to walk with orthotics or independently. CONCLUSION Open fetal surgery enables anatomical repair of the MMC lesion, a potential benefit on cerebral anomalies and motor function, with a low rate of perinatal and maternal complications.
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Affiliation(s)
- Lucie Guilbaud
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - Paul Maurice
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Pauline Lallemant
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Physical Medicine and Rehabilitation, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Timothée De Saint-Denis
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Paris University, AP-HP, Necker Enfants Malades Hospital, Department of Pediatric Neurosurgery, 149 Rue de Sèvres, 75015 Paris, France
| | - Emeline Maisonneuve
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Ferdinand Dhombres
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Stéphanie Friszer
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Federico Di Rocco
- Lyon Claude Bernard University, hôpital Femme-Mère-Enfant, Department of Pediatric Neurosurgery, 59 Boulevard Pinel, 69500 Bron, France
| | - Catherine Garel
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Pediatric Radiology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Marie-Laure Moutard
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Pediatric Neurology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Mohamed-Ali Lachtar
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Neonatal Intensive Care Unit, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Agnès Rigouzzo
- Sorbonne University, AP-HP, Trousseau Hospital, Department of Anesthesiology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Véronique Forin
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Physical Medicine and Rehabilitation, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Michel Zérah
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Paris University, AP-HP, Necker Enfants Malades Hospital, Department of Pediatric Neurosurgery, 149 Rue de Sèvres, 75015 Paris, France
| | - Jean-Marie Jouannic
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
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9
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Kelly EN, Seaward G, Ye XY, Windrim R, Van Mieghem T, Keunen J, Abbasi N, Chitayat D, Ryan G. Short- and long-term outcome following thoracoamniotic shunting for fetal hydrothorax. Ultrasound Obstet Gynecol 2021; 57:624-630. [PMID: 32068931 DOI: 10.1002/uog.21994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/10/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess short- and long-term outcome in a cohort of fetuses diagnosed with hydrothorax (FHT) which underwent thoracoamniotic shunting in utero, and to examine the antenatal predictors of survival and of survival with normal neurodevelopmental outcome. METHODS This was a retrospective analysis of 132 fetuses that underwent thoracoamniotic shunting at our center between 1991 and 2014. Data were extracted from hospital obstetric and relevant neonatal intensive care and neonatal developmental follow-up databases. Outcomes included survival to discharge and survival with normal neurodevelopmental outcome beyond 18 months. Information on malformations, syndromes and genetic abnormalities were obtained from antenatal, postnatal and pediatric hospital records or by parent report. We compared pregnancy characteristics among those who survived vs non-survivors and among those with normal neurodevelopmental outcome vs those who were abnormal or died. We explored whether there was a trend in survival over the study period. RESULTS The mean gestational age at diagnosis of FHT was 25.6 weeks. The fetus was hydropic at diagnosis in 61% of cases, 69% had bilateral effusions and 55% had bilateral shunts inserted. Other diagnoses were present in 24% of cases, two-thirds of which were discovered only postnatally. There were 16 intrauterine and 30 neonatal deaths, with a 65% survival rate overall. The mean gestational age at delivery of liveborns was 35.4 (range, 26.9-41.6) weeks, and 88/116 (76%) were preterm (< 37 weeks). Of 87 liveborn at the treatment center, 75% experienced some respiratory and/or cardiovascular morbidity after birth, many with a lengthy hospital stay (mean, 36 (range, 1-249) days). Overall, 84% of survivors were developmentally normal beyond 18 months and outcomes were better when pleural effusions were isolated, 92% of these cases being neurodevelopmentally normal. There was no trend in survival or neurodevelopmental outcome over time. Despite the presence of FHT and neonatal respiratory issues, most (89%) of the 55 survivors with relevant follow-up had no long-term pulmonary complications. Gestational age at delivery was the only factor independently predictive of both survival and survival with normal neurodevelopmental outcome. CONCLUSIONS FHT is associated with other pathologies in a quarter of cases and carries a significant risk of prematurity, mortality and neonatal morbidity. The outcome is good in survivors but is best in isolated cases. Predictors of outcome at diagnosis are poor. Future improvement in diagnostics at time of identification of FHT may help to identify those that would benefit most from thoracoamniotic shunting. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E N Kelly
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - G Seaward
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - X Y Ye
- Micare Research Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - R Windrim
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - T Van Mieghem
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - J Keunen
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - N Abbasi
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - D Chitayat
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - G Ryan
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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10
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Tulzer A, Arzt W, Tulzer G. Fetal aortic valvuloplasty may rescue fetuses with critical aortic stenosis and hydrops. Ultrasound Obstet Gynecol 2021; 57:119-125. [PMID: 32621387 DOI: 10.1002/uog.22138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/15/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Critical aortic stenosis (CAS) with a restrictive interatrial septum may lead to fetal congestive heart failure and hydrops, usually culminating in fetal demise if left untreated. The aim of this study was to assess the effects of fetal aortic valvuloplasty (FAV) on hemodynamics and outcome in these patients. METHODS This was a retrospective review of fetuses with CAS and signs of hydrops that underwent FAV in our center between 2000 and 2020. Echocardiograms and patients' charts were analyzed for ventricular and valvular dimensions and for outcome. RESULTS Hydrops was present at the time of intervention in 15 fetuses with CAS that underwent FAV at our center during the study period. All but one patient had at least one technically successful procedure. There were no procedure-related deaths, but three intrauterine deaths occurred. Twelve subjects were liveborn, of whom two died within 24 h after birth owing to persistent hydrops. Ventricular function improved and hydrops resolved within 3-4 weeks after FAV in 71.4% (10/14) of fetuses with a technically successful intervention. A biventricular outcome was achieved in 50% of the successfully treated patients. CONCLUSIONS Fetuses with CAS and hydrops can be successfully treated with FAV. The procedure has the potential to restore sufficient fetal cardiac output, which may lead to resolution of hydrops. Surviving patients seem to be good candidates for a biventricular outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Tulzer
- Children's Heart Center Linz, Department of Paediatric Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - W Arzt
- Institute of Prenatal Medicine, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - G Tulzer
- Children's Heart Center Linz, Department of Paediatric Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
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11
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Diehl D, Belke F, Kohl T, Axt-Fliedner R, Degenhardt J, Khaleeva A, Oehmke F, Faas D, Ehrhardt H, Kolodziej M, Uhl E, Windhorst AC, Neubauer BA. Fully percutaneous fetoscopic repair of myelomeningocele: 30-month follow-up data. Ultrasound Obstet Gynecol 2021; 57:113-118. [PMID: 32510722 DOI: 10.1002/uog.22116] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/15/2019] [Revised: 04/27/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This observational study reports on the postnatal mortality and 30-month outcome of children who underwent fully percutaneous fetoscopic repair of myelomeningocele (MMC) at a single center in Giessen, Germany. METHODS Between October 2010 and August 2014, a total of 72 patients underwent fully percutaneous fetoscopic MMC closure at 21 + 0 to 29 + 1 (mean, 23 + 5) weeks' gestation. Of these, 52 (72%) participated in this study; however, 30-month mortality data are available for all 72 children. Children were examined at four timepoints: shortly after birth and at 3 months, 12 months and 30 months of corrected age. The patients underwent age-specific standardized neurological examinations and assessment of leg movements and ambulation at all timepoints. Cognitive and motor development were assessed using the Bayley Scales of Infant Development, second edition (BSID-II), at 30 months. RESULTS All 72 children survived the intrauterine procedure, however, four (5.6%) infants died postnatally (including two of the 52 comprising the study cohort). Of the 52 patients included in the study, 11.5% were delivered before the 30th week of gestation (mean, 33 + 1 weeks) and, of the survivors, 48.1% had ventriculoperitoneal shunt placement. Of the 50 infants that were alive at 30 months, independent ambulation, without orthosis, was feasible for 46%. At 30 months of follow-up, 46% of children presented with a functional level that was at least two segments better than the anatomical level of the lesion. At 30 months, 70% of the children presented with BSID-II psychomotor development index score of ≥ 70 and 80% with BSID-II mental development index score of ≥ 70. CONCLUSION Intrauterine repair of MMC by percutaneous fetoscopy shows largely similar outcomes to those reported for open repair, with respect to mortality, prematurity, shunt-placement rates, motor and mental development and free ambulation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Diehl
- Department of Pediatric Neurology, University Hospital Giessen-Marburg, Giessen, Germany
| | - F Belke
- Department of Pediatric Neurology, University Hospital Giessen-Marburg, Giessen, Germany
| | - T Kohl
- Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany
- German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University of Mannheim (UMM), Mannheim, Germany
| | - R Axt-Fliedner
- Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany
| | - J Degenhardt
- Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany
| | - A Khaleeva
- Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany
| | - F Oehmke
- Department of Gynecology and Obstetrics, Justus-Liebig-University Giessen, Giessen, Germany
| | - D Faas
- Department of Pediatrics and Neonatology, Justus-Liebig-University Giessen, Giessen, Germany
| | - H Ehrhardt
- Department of Pediatrics and Neonatology, Justus-Liebig-University Giessen, Giessen, Germany
| | - M Kolodziej
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - E Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - A C Windhorst
- Institute of Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany
| | - B A Neubauer
- Department of Pediatric Neurology, University Hospital Giessen-Marburg, Giessen, Germany
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12
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Dębska M, Koleśnik A, Kretowicz P, Olędzka A, Rebizant B, Gastoł P, Dębski R. Urethroplasty with balloon catheterization in fetal lower urinary tract obstruction: observational study of 10 fetuses. Ultrasound Obstet Gynecol 2020; 56:916-920. [PMID: 31763721 DOI: 10.1002/uog.21932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/27/2018] [Revised: 09/28/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To present the preliminary outcomes of fetal urethroplasty using a coronary angioplasty balloon catheter in lower urinary tract obstruction (LUTO). METHODS We included 10 consecutive male fetuses diagnosed with LUTO caused by presumed isolated posterior urethral valves (PUVs), who underwent urethroplasty with a balloon catheter in our center between 2015 and 2018. During urethroplasty, the fetal urethra was dilated using a balloon catheter (diameter, 0.014 inches; balloon size, 2 × 9 mm) inserted under ultrasonographic guidance via an 18-gauge needle introduced into the fetal bladder. RESULTS Mean gestational age at the time of urethroplasty was 17.8 (range, 16.5-20.4) weeks. All fetuses survived the procedure without any complications and there was no case of preterm prelabor rupture of the membranes. The procedure was successful in 5/10 (50%) fetuses, while in the other five (50%), we were unable to insert the balloon catheter into the urethra. In the five successfully treated cases, mean gestational age at delivery was 38 (range, 36-40) weeks and presence of PUVs was confirmed after birth. All five neonates micturated spontaneously and presented with normal urine output after birth. During the follow-up period, the parameters of kidney function were within normal limits in two neonates, whereas signs of impaired renal function were seen in another two. The other was diagnosed with renal insufficiency and required kidney transplant with bladder sparing at 2 years of age. CONCLUSIONS Urethroplasty with a balloon catheter is a new prenatal treatment option for fetuses with PUVs. By restoring fetal micturition, the procedure can preserve normal urinary bladder and kidney function. Although data on its efficacy and potential to differentiate the etiology of LUTO are sparse, a significant advantage of this method is its safety for the fetus and the mother. Even if the neonates develop renal insufficiency, they may be eligible for kidney transplant with connection to their own bladder, without the need for urostomy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Dębska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Koleśnik
- Cardiac Catheterization Laboratory, Children's Memorial Health Institute, Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Kretowicz
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Olędzka
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - B Rebizant
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Gastoł
- Department of Pediatric Urology, Children's Memorial Health Institute, Warsaw, Poland
| | - R Dębski
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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14
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Abstract
Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.
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Affiliation(s)
- Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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15
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Cimpoca B, Syngelaki A, Litwinska E, Muzaferovic A, Nicolaides KH. Increased nuchal translucency at 11-13 weeks' gestation and outcome in twin pregnancy. Ultrasound Obstet Gynecol 2020; 55:318-325. [PMID: 31773823 DOI: 10.1002/uog.21935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the value of increased fetal nuchal translucency thickness (NT) at the 11-13-week scan in the prediction of adverse outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies. METHODS This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major defects or chromosomal abnormalities, we examined the value of increased NT ≥ 95th percentile in one or both fetuses in the prediction of, first, miscarriage or death of one or both fetuses at < 20 and < 24 weeks' gestation in DC, MCDA and MCMA twin pregnancies, second, death of one or both fetuses or neonates at ≥ 24 weeks in DC, MCDA and MCMA twin pregnancies, third, development of twin-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) treated by endoscopic laser surgery at < 20 and ≥ 20 weeks' gestation in MCDA pregnancies, and, fourth, either fetal loss or laser surgery at < 20 weeks' gestation in MCDA pregnancies. RESULTS The study population of 6225 twin pregnancies included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA pregnancies. The incidence of NT ≥ 95th percentile in one or both fetuses in DC twin pregnancies was 8.3%; in MCDA twins the incidence was significantly higher (10.4%; P = 0.016), but in MCMA twins it was not significantly different (9.1%; P = 0.804) from that in DC twins. In DC twin pregnancies, the incidence of high NT was not significantly different between those with two survivors and those with adverse outcome. In MCMA twin pregnancies, the number of cases was too small for meaningful assessment of the relationship between high NT and adverse outcome. In MCDA twin pregnancies with at least one fetal death or need for endoscopic laser surgery at < 20 weeks' gestation, the incidence of NT ≥ 95th percentile was significantly higher than in those with two survivors (23.5% vs 9.8%; P < 0.0001). Kaplan-Meier analysis in MCDA twin pregnancies showed that, in those with NT ≥ 95th percentile, there was significantly lower survival at < 20 weeks' gestation than in those with NT < 95th percentile (P = 0.001); this was not the case for survival at ≥ 20 weeks (P = 0.960). The performance of screening by fetal NT ≥ 95th percentile for prediction of either fetal loss or need for endoscopic laser surgery at < 20 weeks' gestation was poor, with a detection rate of 23.5% at a false-positive rate of 8.9%, and the relative risk, in comparison to fetal NT < 95th percentile, was 2.640 (95% CI, 1.854-3.758; P < 0.0001). In MCDA twin pregnancies, the overall rate of fetal loss or need for laser surgery at < 20 weeks' gestation was 10.7% but, in the subgroups with NT ≥ 95th and NT ≥ 99th percentiles, which constituted 10.4% and 3.3% of the total, the rates increased to 24.1% and 40.5%, respectively. CONCLUSIONS In MCDA twin pregnancies with no major fetal abnormalities, measurement of NT at the 11-13-week scan is a poor screening test for adverse pregnancy outcome. However, the finding in one or both fetuses of NT ≥ 95th percentile, and more so ≥ 99th percentile, is associated with a substantially increased risk of fetal loss or need for endoscopic laser surgery at < 20 weeks' gestation. The extent to which closer monitoring and earlier intervention in the high-risk group can reduce these complications remains to be determined. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Cimpoca
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Litwinska
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Muzaferovic
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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16
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Buffin-Meyer B, Tkaczyk M, Stańczyk M, Breuil B, Siwy J, Szaflik K, Talar T, Wojtera J, Krzeszowski W, Decramer S, Klein J, Schanstra JP. A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves. Pediatr Nephrol 2020; 35:469-475. [PMID: 31701236 DOI: 10.1007/s00467-019-04390-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Posterior urethral valves (PUVs) account for 17% of pediatric renal failure. The management of pregnancies involving fetuses with PUV is hampered by the fact that current clinical parameters obtained from fetal ultrasound and/or fetal urine biochemistry are insufficient to predict postnatal renal function. We previously have developed a fetal urine peptide signature (12PUV) that predicted with high precision postnatal renal failure at 2 years of age in fetuses with PUV. Here, we evaluated the accuracy of this signature to predict postnatal renal outcome in fetuses with PUV in an independent single-center study. METHODS Thirty-three women carrying fetuses with suspected PUV were included. Twenty-five fetuses received vesicoamniotic shunts during pregnancy. PUV was confirmed postnatally in 23 patients. Of those 23 fetuses, 2 were lost in follow-up. Four and 3 patients died in the pre- and perinatal periods, respectively. Follow-up renal function at 6 months of age was obtained for the remaining 14 patients. The primary outcome was early renal failure, defined by an eGFR < 60 mL/min/1.73 m2 before 6 months of age or pre- or perinatal death. RESULTS The peptide signature predicted postnatal renal outcome in postnatally confirmed PUV fetuses with an AUC of 0.94 (95%CI 0.74-1.0) and an accuracy of 90% (95%CI 78-100). The signature predicted postnatal renal outcome for the suspected PUV cases with an AUC of 0.89 (95%CI 0.72-0.97) and an accuracy of 84% (95%CI 71-97). CONCLUSIONS This single-center study confirms the predictive power of the previously identified 12PUV fetal urinary peptide signature.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Krzysztof Szaflik
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Justyna Wojtera
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Waldemar Krzeszowski
- Department of Genecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
- Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
- Centre de Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.
- Université Toulouse III Paul-Sabatier, Toulouse, France.
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17
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Abstract
BACKGROUND Fetal pleural effusions are a rare fetal anomaly that may result from congenital chylothorax. Severe cases lead to chest compression with resulting pulmonary hypoplasia and possible neonatal demise. Fetal thoracoamiontic shunt (TAS) placement may decrease the amount of pleural effusion and improve lung expansion. CASE A 30-year-old primigravida at 29 2/7 weeks' gestation presented with fetal bilateral pleural effusions with no identifiable genetic or structural abnormalities. TAS placement accomplished decompression of the left fetal chest. The neonate was delivered at 33 3/7 weeks and required minimal respiratory support with no apparent long term complications at discharge. CONCLUSION This case demonstrated that fetal intervention with TAS placement can improve neonatal outcomes. Referral to an MFM specialist capable of TAS should be considered for isolated fetal bilateral pleural effusion.
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Affiliation(s)
- D M Hannah
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; The Medical Center Navicent Health, Mercer University School of Medicine, Macon, GA, USA
| | - M L Badell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; Emory University School of Medicine, Atlanta, GA, USA
| | - P C Woodham
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; The Medical Center Navicent Health, Mercer University School of Medicine, Macon, GA, USA
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18
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Nassr AA, Shamshirsaz AA, Erfani H, Espinoza J, Sanz Cortes M, Koh CJ, Roth DR, Angelo JR, Mandy GT, Braun MC, Ruano R, Belfort MA. Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in second trimester of pregnancy. Ultrasound Obstet Gynecol 2019; 54:500-505. [PMID: 30977189 DOI: 10.1002/uog.20288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/02/2019] [Revised: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Congenital lower urinary tract obstruction (LUTO) is a rare condition with high perinatal mortality and morbidity when associated with severe oligohydramnios or anhydramnios in the second trimester of pregnancy. Severe pulmonary hypoplasia and end-stage renal disease are the underlying causes of poor neonatal outcome in these cases. However, little is known about the subset of fetal LUTO that is associated with a normal volume of amniotic fluid at midgestation. The objective of the current study was to describe the natural history, underlying causes, survival and postnatal renal function outcomes in pregnancies with fetal LUTO and normal amniotic fluid volume during the second trimester of pregnancy. METHODS This was a retrospective study of all pregnancies with fetal LUTO and normal amniotic fluid volume in the second trimester that received prenatal and postnatal care at our quaternary care institution between 2013 and 2017. Data on demographic characteristics, fetal interventions, perinatal survival, need for neonatal respiratory support, postnatal renal function and need for dialysis at the age of 1 and 24 months were analyzed. RESULTS Of the 18 fetuses that met the study criteria, 17 (94.4%) survived the perinatal period. Eleven (61.1%) pregnancies developed oligohydramnios in the third trimester, six of which were eligible for and underwent fetal intervention with vesicoamniotic shunt placement, which was performed successfully in all six cases. Two (11.1%) neonates required respiratory support owing to pulmonary hypoplasia. At the age of 2 years, 14 children had follow-up information available, two (14.3%) of whom had normal renal function, eight (57.1%) had developed some degree of chronic kidney disease (Stage 1-4) and four (28.6%) had developed end-stage renal disease (ESRD), including two who had already manifested ESRD in the neonatal period. CONCLUSIONS Most fetuses diagnosed prenatally with LUTO that is associated with a normal volume of amniotic fluid at midgestation will have a favorable outcome in terms of perinatal survival and few will need long-term respiratory support. However, these children are still at increased risk for chronic renal disease, ESRD and need for renal replacement therapy. Larger multicenter studies are needed to characterize the prenatal factors associated with postnatal renal function, and to investigate the role of fetal intervention in the group of fetuses that present with late-onset oligohydramnios and evidence of preserved fetal renal function. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - H Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - C J Koh
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - D R Roth
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J R Angelo
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - G T Mandy
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M C Braun
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - R Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
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Sakamoto N, Mitsuzuka K, Kanno Y, Hayashi M, Goto Y, Ueno S, Ishimoto H. Atypical Presentation of Duodenal Atresia Concomitant with Type-A Esophageal Atresia in Fetal Life: A Case Report. Tokai J Exp Clin Med 2019; 44:31-33. [PMID: 31250423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Abstract
Duodenal atresia concomitant with type-A esophageal atresia (DA + TA-EA) is rare. A pronounced enlargement of a closed loop of the upper gastrointestinal tract serves as an early clue for its prenatal detection. We describe an atypical case of DA + TA-EA in which the dilatation of the upper gastrointestinal tract remained mild. Ultrasonographic examination at 28 weeks of gestation showed mild polyhydramnios. Subsequent detailed sonographic and magnetic resonance imaging studies revealed a mildly enlarged stomach and duodenum that resembled a "double bubble," mild ascites, and polydactyly of the right thumb. Fetal abdominal circumference measurements were within normal range. A female neonate born at 36 weeks gestation did not show abdominal distension. DA + TA-EA was diagnosed based on clinical characteristics and X-ray studies of the neonate; the diagnosis was confirmed by surgery. Duodenoduodenostomy and gastrostomy in the first week of life and esophagoesophagostomy at six months of age were performed with satisfactory results, and the infant developed well. Prominent and/or increasing C-shaped fluid collection in the upper abdomen is a highly useful diagnostic sign for DA + TA-EA, but it is not applicable for all fetuses with this disease. Physicians should bear this caveat in mind to avoid diagnostic delays and initiate prompt postnatal therapy.
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Affiliation(s)
| | | | | | | | | | | | - Hitoshi Ishimoto
- Department of Obstetrics and Gynecology, Specialized Clinical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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20
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Said SM, Qureshi MY, Taggart NW, Anderson HN, O'Leary PW, Cetta F, Alrahmani L, Cofer SA, Segura LG, Pike RB, Sharpe EE, Derleth DP, Nemergut ME, Van Dorn CS, Gleich SJ, Rose CH, Collura CA, Ruano R. Innovative 2-Step Management Strategy Utilizing EXIT Procedure for a Fetus With Hypoplastic Left Heart Syndrome and Intact Atrial Septum. Mayo Clin Proc 2019; 94:356-361. [PMID: 30711131 DOI: 10.1016/j.mayocp.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/17/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) with intact atrial septum (HLHS-IAS) carries a high risk of mortality and affects about 6% of all patients with HLHS. Fetal interventions, postnatal transcatheter interventions, and postnatal surgical resection have all been used, but the mortality risk continues to be high in this subgroup of patients. We describe a novel, sequential approach to manage HLHS-IAS and progressive fetal hydrops. A 28-year-old, gravida 4 para 2 mother was referred to Mayo Clinic for fetal HLHS. Fetal echocardiography at 28 weeks of gestation demonstrated HLHS-IAS with progressive fetal hydrops. The atrial septum was thick and muscular with no interatrial communication. Ultrasound-guided fetal atrial septostomy was performed with successful creation of a small atrial communication. However, fetal echocardiogram at 33 weeks of gestation showed recurrence of a pleural effusion and restriction of the atrial septum. We proceeded with an Ex uteroIntrapartum Treatment (EXIT) delivery and open atrial septectomy. This was performed successfully, and the infant was stabilized in the intensive care unit. The infant required venoarterial extracorporeal membrane oxygenator support on day of life 1. The patient later developed hemorrhagic complications, leading to his demise on day of life 9. This is the first reported case of an EXIT procedure and open atrial septectomy performed without cardiopulmonary bypass for an open-heart operation and provides a promising alternative strategy for the management of HLHS-IAS in select cases.
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Affiliation(s)
- Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Heather N Anderson
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Patrick W O'Leary
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Frank Cetta
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Layan Alrahmani
- Division of Obstetrics and Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Shelagh A Cofer
- Division of Pediatric Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, MN
| | - Leal G Segura
- Division of Pediatric Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Roxann B Pike
- Division of Cardiovascular Anesthesia, Mayo Clinic College of Medicine, Rochester, MN
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Douglas P Derleth
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Michael E Nemergut
- Division of Pediatric Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Charlotte S Van Dorn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Stephen J Gleich
- Division of Pediatric Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Carl H Rose
- Division of Obstetrics and Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Rodrigo Ruano
- Division of Obstetrics and Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN.
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21
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Baba JS, McKnight TE, Ericson MN, Johnson A, Moise KJ, Evans BM. Characterization of a reversible thermally-actuated polymer-valve: A potential dynamic treatment for congenital diaphragmatic hernia. PLoS One 2018; 13:e0209855. [PMID: 30589888 PMCID: PMC6307748 DOI: 10.1371/journal.pone.0209855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a fetal defect comprising an incomplete diaphragm and the herniation of abdominal organs into the chest cavity that interfere with fetal pulmonary development. Though the most promising treatment for CDH is via interventional fetoscopic tracheal occlusion (TO) surgery in-utero, it has produced mixed results due to the static nature of the inserted occlusion. We hypothesize that a suitable noninvasively-actuatable, cyclic-release tracheal occlusion device can be developed to enable dynamic tracheal occlusion (dTO) implementation. OBJECTIVE To conduct an in-vitro proof-of-concept investigation of the construction of thermo-responsive polymer valves designed for targeted activation within a physiologically realizable temperature range as a first step towards potential development of a noninvasively-actuatable implantable device to facilitate dynamic tracheal occlusion (dTO) therapy. METHODS Six thermo-responsive polymer valves, with a critical solution temperature slightly higher than normal physiological body temperature of 37°C, were fabricated using a copolymer of n-isopropylacrylamide (NIPAM) and dimethylacrylamide (DMAA). Three of the valves underwent ethylene oxide (EtO) sterilization while the other three served as controls for EtO-processing compatibility testing. Thermal response actuation of the valves and their steady-state flow performances were evaluated using water and caprine amniotic fluid. RESULTS All six valves consisting of 0.3-mole fraction of DMAA were tested for thermal actuation of caprine amniotic fluid flow at temperatures ranging from 30-44°C. They all exhibited initiation of valve actuation opening at ~40°C with full completion at ~44°C. The overall average coefficient of variation (CV) for the day-to-day flow performance of the valves tested was less than 12%. Based on a Student t-test, there was no significant difference in the operational characteristics for the EtO processed versus the non-EtO processed valves tested. CONCLUSIONS We successfully fabricated and demonstrated physiological realizable temperature range operation of thermo-responsive polymer valves in-vitro and their suitability for standard EtO sterilization processing, a prerequisite for future in-vivo surgical implantation testing.
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Affiliation(s)
- Justin S. Baba
- Electrical and Electronics Systems Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, United States of America
- Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Timothy E. McKnight
- Electrical and Electronics Systems Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, United States of America
| | - M. Nance Ericson
- Electrical and Electronics Systems Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, United States of America
| | - Anthony Johnson
- Department of Obstetrics, Gynecology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kenneth J. Moise
- Department of Obstetrics, Gynecology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Boyd M. Evans
- Electrical and Electronics Systems Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, United States of America
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22
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Abstract
Congenital causes of airway obstruction once noted at birth are now diagnosed prenatally. The adoption of ex utero intrapartum treatment has allowed for planned airway stabilization on placental support, dramatically decreasing the incidence of hypoxic injury or peripartum demise related to neonatal airway obstruction. Airway access is gained either through laryngoscopy, bronchoscopy, or a surgical airway. In complete airway obstruction, primary resection of the obstructing lesion may be performed before completion of delivery. This article reviews the current and emerging methods of fetal evaluation, indications for ex utero intrapartum treatment, and provides a detailed description of the procedure and necessary personnel.
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Affiliation(s)
- Kara Prickett
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, 1400 Tullie Road, NE, Atlanta, GA 30329, USA.
| | - Luv Javia
- Cochlear Implant Program, Center for Pediatric Airway Disorders, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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23
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Abstract
In today's era of improved antenatal care and screening modalities (3D high-resolution fetal ultrasound, fetal magnetic resonance imaging, fetal echocardiography, maternal serum markers and fetal blood sampling), an early diagnosis of surgical fetal abnormalities is routinely possible. A thorough knowledge about the incidence of such defects, the means of detection and evaluation, the scope of fetal intervention, postnatal management and long-term outcomes of common surgical conditions diagnosed antenatally is essential. This knowledge would not only help in proper patient care and management but also to ensure appropriate counselling of the expectant parents. This article highlights the fetal anomalies which are amenable to some form of fetal intervention from a pediatric surgical perspective as also those which can be treated after birth.
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Affiliation(s)
- Kashish Khanna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
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24
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Baschat AA, Ahn ES, Murphy J, Miller JL. Fetal blood-gas values during fetoscopic myelomeningocele repair performed under carbon dioxide insufflation. Ultrasound Obstet Gynecol 2018; 52:400-402. [PMID: 29750436 DOI: 10.1002/uog.19083] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 03/21/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Fetoscopic myelomeningocele (MMC) repair is performed using intrauterine carbon dioxide (CO2 ) insufflation. Sheep experiments have shown that CO2 insufflation is associated with significant fetal acidemia; however, corresponding data for human pregnancy are not available. We performed umbilical venous cord blood sampling in three patients during fetoscopic MMC repair at 25 + 1, 25 + 3 and 24 + 0 weeks' gestation, respectively. Fetal venous pH at the beginning of CO2 insufflation was 7.36, 7.46 and 7.37, respectively in the three fetuses, and repeat values were 7.28, 7.35 and 7.36 after 181, 159 and 149 min, respectively. The partial pressure of oxygen and CO2 was maintained in the normal range during these times, and pH decrease was less in Patient 3 who received humidified CO2 insufflation. Our observations suggest that, in contrast to sheep experiments, CO2 insufflation during fetoscopic myelomeningocele repair does not cause acidemia in human fetuses. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Baschat
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - E S Ahn
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Murphy
- Division of Obstetric Anesthesiology, Department of Anesthesia & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J L Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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25
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Moise KJ, Spike JP. Fetal blood gases at fetoscopic myelomeningocele repair. Ultrasound Obstet Gynecol 2018; 52:411-412. [PMID: 30022559 DOI: 10.1002/uog.19161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- K J Moise
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern School of Medicine - UT Health, 6410 Fannin Street, Suite, 700, Houston, Texas, USA
| | - J P Spike
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern School of Medicine - UT Health, 6410 Fannin Street, Suite, 700, Houston, Texas, USA
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Cao KX, Booth A, Ourselin S, David AL, Ashcroft R. The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States. Prenat Diagn 2018; 38:475-481. [PMID: 29663461 PMCID: PMC6033164 DOI: 10.1002/pd.5267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/06/2022]
Abstract
The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.
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Affiliation(s)
- Kevin X. Cao
- Department of UrologyGreat Ormond Street HospitalLondonUK
| | | | | | - Anna L. David
- UCL Institute for Women's HealthLondonUK
- Department of Development and RegenerationKatholieke Universiteit LeuvenLeuvenBelgium
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Crowe L, Graham RH, Robson SC, Rankin J. A survey of health professionals' views on acceptable gestational age and termination of pregnancy for fetal anomaly. Eur J Med Genet 2018; 61:493-498. [PMID: 29777898 DOI: 10.1016/j.ejmg.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
Abstract
Termination of pregnancy for fetal anomaly is legal in the UK with no upper limit, if two doctors, in good faith, agree "there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped". This is Clause E of the Human Fertlisation and Embryology Act. The most commonly sighted Clause is C, which states "the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman". This study aimed to investigate health professionals' views on gestational age and acceptable termination of pregnancy for fetal anomaly (TOPFA). We undertook a questionnaire survey of UK health professionals working in fetal medicine, obstetrics and gynaecology and neonatology. A study pack consisting of a self-completion questionnaire, an invitation letter, participant information sheet, and a stamped addressed return envelope, were sent to health professionals. We used four fetal anomalies as case study examples in the questionnaire: isolated cleft lip, hypoplastic left heart, spina bifida and trisomy 21. These anomalies were chosen as they differed in terms of the type of anomaly, the type of impairment, and the perceived severity. Forty-one study packs were returned. For anomalies deemed less serious, later gestational ages were an important consideration when deciding acceptable TOPFA. The prognosis of an anomaly was considered an important factor in deciding whether a TOPFA was acceptable alongside gestational age. Clause C of the current UK legislation, which allows a legal termination prior to 24 weeks gestational age if continuing with the pregnancy would impact the mental health of the mother, was deemed a reasonable option for termination when parents are requesting a TOPFA. For each case study example, health professionals responded that TOPFA at '25 weeks and over' was acceptable (cleft lip n = 1; hypoplastic left heart n = 19; spina bifida n = 13 and Trisomy 21 n = 10). Professionals also distinguished between their personal and professional views. These findings offer new insight into how gestational age considerations influence professionals' conceptualisation of acceptable TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK.
| | - Ruth H Graham
- School of Geography, Politics and Sociology, 5th Floor Claremont Bridge Building, Newcastle University, NE1 7RU, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, 3rd Floor William Leech Building, Newcastle University, NE2 4HH, UK
| | - Judith Rankin
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK
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Baumgarten HD, Gebb JS, Khalek N, Moldenhauer JS, Johnson MP, Peranteau WH, Hedrick HL, Adzick NS, Flake AW. Preemptive Delivery and Immediate Resection for Fetuses with High-Risk Sacrococcygeal Teratomas. Fetal Diagn Ther 2018; 45:137-144. [PMID: 29734172 DOI: 10.1159/000487542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fetuses with "high-risk" sacrococcygeal teratoma (SCT) have a mortality rate of 40-50%. While fetal surgery may benefit select fetuses prior to 27 weeks' gestation, many fetuses die due to consequences of rapid tumor growth after 27 weeks. Here we report our experience applying "preemptive" delivery to fetuses who manifest signs of decompensation between 27 and 32 weeks. METHODS A retrospective review of SCT fetuses delivered between 2010 and 2016 at ≤32 weeks' gestation was performed. Patients who decompensated prior to 27 weeks and were treated with fetal surgery or neonatal palliation were excluded. RESULTS Forty-two SCT fetuses were evaluated, and 11 were preemptively delivered in response to impending fetal or maternal decompensation. Nine (81.8%) survived. One death was due to pulmonary hypoplasia in a neonate with significant intra-abdominal tumor burden, and the other was due to in utero tumor rupture. There were no deaths related to prematurity in this cohort. CONCLUSIONS Many fetuses with SCT manifest signs of decompensation between 27 and 32 weeks. In the absence of fetal hydrops prior to 27 weeks or tumor rupture in utero, early delivery is associated with favorable outcomes. Our single-center experience supports a management algorithm change to incorporate "preemptive" delivery for selected cases.
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29
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Antiel RM, Curlin FA, Lantos JD, Collura CA, Flake AW, Johnson MP, Rintoul NE, Brown SD, Feudtner C. Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions. J Med Ethics 2018; 44:234-238. [PMID: 29018178 DOI: 10.1136/medethics-2017-104377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/14/2017] [Revised: 07/14/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. METHODS Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs). RESULTS Of 1176 eligible physicians, 670 (57%) responded (range by specialty, 54%-60%). In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed (59%) or strongly disagreed (19%) that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong (OR 1.75; 95%CI 1.0 to 3.05). Older physicians were less likely to recommend surgery (OR 0.57; 95%CI 0.36 to 0.88). For non-lethal conditions, most respondents agreed (66% somewhat, 4% strongly) that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious (ORs range from 0.45 to 0.64). CONCLUSION Physician's attitudes about prenatal surgery relate to physicians' beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.
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Affiliation(s)
- Ryan M Antiel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Farr A Curlin
- Trent Center for Bioethics, Humanities and History of Medicine, Duke University, Durham, North Carolina, USA
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Alan W Flake
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mark P Johnson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Natalie E Rintoul
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Gielchinsky Y, Valsky DV, Yanai N, Abdeljawad FJ, Muhaisen MA, Arbell D, Ginosar Y, Ben-Yosef O, Winograd O, Bar-Oz B, Yagel S, Eventov-Friedman S. [ADVANCES IN FETAL THERAPY IN COMPLICATED MONOCHORIONIC PREGNANCIES AND IN SEVERE CONGENITAL DIAPHRAGMATIC HERNIA: FIVE YEARS EXPERIENCE]. Harefuah 2018; 157:170-174. [PMID: 29582948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION : Minimally invasive fetal therapeutic procedures reduce the morbidity and mortality in monochorionic (MC) twins and in fetuses with congenital diaphragmatic hernia (CDH). MC pregnancies share their blood systems due to communicating vessels over their single placenta and may develop specific complications: Twin-to-Twin transfusion syndrome (TTTS), Selective intrauterine growth restriction (sIUGR), Twin Anemia-Polycythemia Sequence (TAPS), Twin Reverse Arterial Perfusion Syndrome (TRAP) or anomalies in one. Half of complicated MC require intrauterine interventions. Severe CDH is linked to a high rate of neonatal death due to pulmonary hypoplasia. Fetoscopic tracheal occlusion (FETO) with a balloon improves postnatal outcome. AIMS A fetal therapy center was established in the Hadassah Medical Centers, Jerusalem in 2011 for intrauterine interventions. We report our 5 years' experience. METHODS This prospective cohort follows the outcome of MC pregnancies and cases of severe CDH which underwent therapeutic fetal procedures in Hadassah between the years 2011-16. RESULTS Out of 114 procedures, 95 were in MC: 84 monochorionic diamniotic twins, 7 monochorionic monoamniotic twins, 2 dichorionic triamniotic triplets and 2 monochorionic triplets. We treated 65 TTTS cases with fetoscopy and laser ablation of communicating vessels. The survival rate of both twins was 58.5% and at least one survived in 81.5% of the cases. In 2nd/3rd trimesters selective termination of 15 cases the survival rate of the remaining twin was 87%. In 11 cases of TRAP sequence treated with laser ablation of the feeding vessel the survival of the remaining twin was 91%. In 19 fetoscopies in severe CDH, 12 were for balloon insertion and 7 for removal. Endotracheal balloon was successfully placed in 11 of 12 cases (10 left-sided, 1 right-sided CDH). Balloon removal was prenatally performed by elective fetoscopy (n=7) or by intrapartum urgent puncture. There were no intrauterine fetal deaths. In isolated left-sided CDH the survival was 57%, whereas none survived in non-isolated left-sided CDH and right sided CDH. CONCLUSIONS In-utero procedures are safe for the mother and increase newborn survival in MC pregnancies, thus specialized clinics are life-saving. FETO is a therapeutic option for severe CDH. Our results meet similar achievements reported by other leading world centers.
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Affiliation(s)
- Yuval Gielchinsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dan V Valsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nili Yanai
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Firas J Abdeljawad
- Department of Obstetrics and Gynecology, Makassed Hospital, Jerusalem, Israel
| | - Mazen A Muhaisen
- Department of Obstetrics and Gynecology, Makassed Hospital, Jerusalem, Israel
| | - Dan Arbell
- Department of Pediatric Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yehuda Ginosar
- Department of Anesthesia, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Orna Ben-Yosef
- Operating Room Department, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Orite Winograd
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Benjamin Bar-Oz
- Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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de Oliveira GH, Svetliza J, Vaz-Oliani DCM, Liedtke H, Oliani AH, Pedreira DAL. Novel multidisciplinary approach to monitor and treat fetuses with gastroschisis using the Svetliza Reducibility Index and the EXIT-like procedure. Einstein (Sao Paulo) 2017; 15:395-402. [PMID: 29364360 PMCID: PMC5875150 DOI: 10.1590/s1679-45082017ao3979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe our initial experience with a novel approach to follow-up and treat gastroschisis in "zero minute" using the EXITlike procedure. METHODS Eleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as historical controls. The Svetliza Reductibility Index consisted in dividing the real abdominal wall defect diameter by the larger intestinal loop to be fitted in such space. The EXIT-like procedure consists in planned cesarean section, fetal analgesia and return of the herniated viscera to the abdominal cavity before the baby can fill the intestines with air. No general anesthesia or uterine relaxation is needed. Exteriorized viscera reduction is performed while umbilical cord circulation is maintained. RESULTS Four of the five cases were performed with the EXIT-like procedure. Successful complete closure was achieved in three infants. The other cases were planned deliveries at term and treated by construction of a Silo. The average time to return the viscera in EXIT-like Group was 5.0 minutes, and, in all cases, oximetry was maintained within normal ranges. In the perinatal period, there were significant statistical differences in ventilation days required (p = 0.0169), duration of parenteral nutrition (p=0.0104) and duration of enteral feed (p=0.0294). CONCLUSION The Svetliza Reductibility Index and EXIT-like procedure could be new options to follow and treat gastroschisis, with significantly improved neonatal outcome in our unit. Further randomized studies are needed to evaluate this novel approach.
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Affiliation(s)
| | - Javier Svetliza
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Humberto Liedtke
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Antonio Helio Oliani
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Mesas Burgos C, Conner P, Papatziamos G, Tiblad E. [Advances in fetal surgery]. Lakartidningen 2017; 114:EM6E. [PMID: 28850156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Advances in fetal surgery Fetal surgery is a subspeciality that is evolving rapidly with focus on improving the natural history of congenital malformations and conditions that are either life threatening or cause severe disability. Fetal surgery for myelomeningocele has been shown to improve neurologic outcome, motor function and to reduce the need of ventriculo-peritoneal shunting after birth compared to postnatal care. However, it conveys an increased risk of preterm birth and maternal morbidity. The role of prenatal intervention with endoscopic tracheal occlusion in congenital diaphragmatic hernia is currently the focus of an ongoing multicenter randomized controlled trial. The trial is comparing the effect of fetal surgery as an alternative to standard postnatal management. The main, but not sole, indication for an Ex-utero intrapartum treatment (EXIT) is airway obstruction due to laryngeal atresia and tumors in the head and neck region. It is a complex procedure that should be performed only in experienced centers with a multidisciplinary team.
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Affiliation(s)
- Carmen Mesas Burgos
- Karolinska Universitetssjukhuset - Pediatric Surgery Stockholm, Sweden Karolinska Universitetssjukhuset - Pediatric Surgery Stockholm, Sweden
| | - Peter Conner
- Karolinska Universitetssjukhuset - Centrum för Fostermedicin Stockholm, Sweden Karolinska Universitetssjukhuset - Centrum för Fostermedicin Stockholm, Sweden
| | - Georgios Papatziamos
- Karolinska Universitetssjukhuset - ENT Surgery Stockholm, Sweden Karolinska Universitetssjukhuset - ENT Surgery Stockholm, Sweden
| | - Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital - Stockholm, Sweden - Center for Fetal Medicine Stockholm, Sweden
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Tiblad E, Ek S, Kublickas M, Lindgren P. [Invasive fetal therapy]. Lakartidningen 2017; 114:ELXE. [PMID: 28850167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Invasive fetal therapy Invasive fetal therapy in Sweden consists of fetoscopic interventions to treat twin-to-twin transfusion syndrome (TTS) or twin anemia polycytemia sequence (TAPS) in monochorionic twin or triplet pregnancies and for selective reduction in monochorionic twins complicated by discordant anomalies or severe growth retardation in one fetus. Alternative methods, such as intrafetal laser ablation and radio frequency ablation, are also used for selective reduction and rarely to treat fetal tumors. Ultrasound guided intrauterine blood transfusions to treat fetal anemia have been performed for a long time with excellent results. Placement of thoraco-amniotic shunts and vesico-amniotic shunts is indicated in a few cases per year in Sweden. Since these rare interventions were centralized to one national center in 2013, the outcome of the fetal interventions has improved consistently.
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Affiliation(s)
- Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital - Stockholm, Sweden - Center for Fetal Medicine Stockholm, Sweden
| | - Sverker Ek
- Center for Fetal Medicine - Karolinska University Hospital Stockholm, Sweden Center for Fetal Medicine - Karolinska University Hospital Stockholm, Sweden
| | - Marius Kublickas
- Center for Fetal Medicine - Karolinska University Hospital Stockholm, Sweden Center for Fetal Medicine - Karolinska University Hospital Stockholm, Sweden
| | - Peter Lindgren
- Kvinnokliniken Karolinska Universitetssjukhuset - Stockholm, Sweden Kvinnokliniken Karolinska Universitetssjukhuset - Stockholm, Sweden
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Abstract
BACKGROUND Administering anesthesia for prenatal repair of myelomeningocele reveals several issues that are unique to this new form of treatment. This includes issues such as fetal well-being, surgical conditions and monitoring, among others. Exploring, analyzing, and understanding the different variables that are involved will help us reduce the high level of risk associated with this surgery. OBJECTIVE This review provides a systematic approach to the issues that are faced by anesthesiologists during fetal surgery.
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Affiliation(s)
- Juan Carlos Devoto
- Department of Anesthesiology, Fetal Surgery Program, Clínica las Condes, Lo fontecilla 441 Las Condes, 7591046, Santiago, Chile.
| | - Juan Luis Alcalde
- Department of Gynecology and Obstetrics, Fetal Surgery Program, Clínica Las Condes, Santiago, Chile
| | - Felipe Otayza
- Department of Neurosurgery, Fetal Surgery Program, Clínica Las Condes, Santiago, Chile
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Cavalheiro S, da Costa MDS, Mendonça JN, Dastoli PA, Suriano IC, Barbosa MM, Moron AF. Antenatal management of fetal neurosurgical diseases. Childs Nerv Syst 2017; 33:1125-1141. [PMID: 28555310 PMCID: PMC5496971 DOI: 10.1007/s00381-017-3442-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.
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Affiliation(s)
- Sergio Cavalheiro
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil.
| | - Marcos Devanir Silva da Costa
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Jardel Nicacio Mendonça
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Patricia Alesssandra Dastoli
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Italo Capraro Suriano
- Department of Neurosurgery, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Mauricio Mendes Barbosa
- Department of Gynecology and Obstetrics, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
| | - Antonio Fernandes Moron
- Department of Gynecology and Obstetrics, Federal University of Sao Paulo, Rua Botucatu, 591, conj 41, Sao Paulo, SP, CEP: 04023-062, Brazil
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Nassr AA, Shazly SAM, Abdelmagied AM, Araujo Júnior E, Tonni G, Kilby MD, Ruano R. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49:696-703. [PMID: 27270578 DOI: 10.1002/uog.15988] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 02/08/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect on perinatal and postnatal survival of vesicoamniotic shunt (VAS) as treatment for fetal lower urinary tract obstruction (LUTO). METHODS An electronic search of Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus using relevant search terms was conducted from inception to June 2015 to identify studies comparing outcomes of VAS vs conservative management for treatment of LUTO. Cohort studies and clinical trials were considered eligible. Single-arm studies and studies that did not report survival were excluded. Sample size and language were not criteria for exclusion. Two reviewers extracted independently data in a standardized form, including study characteristics and results. Primary outcomes were perinatal and postnatal survival. Secondary outcome was postnatal renal function. Data on fetal survival were expressed as odds ratio (OR) and 95% CI. RESULTS Of the 423 abstracts retrieved, nine studies were eligible for inclusion. These studies included 112 fetuses treated with VAS and 134 that were managed conservatively. There was heterogeneity in study design. Although the data demonstrated a difference in effect estimates between the study arms in terms of perinatal survival (OR, 2.54 (95% CI, 1.14-5.67)), there was no difference in 6-12-month survival (OR, 1.77 (95% CI, 0.25-12.71)) or 2-year survival (OR, 1.81 (95% CI, 0.09-38.03)). In addition, there was no difference in effect on postnatal renal function between fetuses that underwent intervention and those that did not (OR, 2.09 (95% CI, 0.74-5.94)). CONCLUSIONS Available data seem to support an advantage for perinatal survival in fetuses treated with VAS compared with conservative management. However, 1-2-year survival and outcome of renal function after VAS procedure remain uncertain. Further studies are necessary to evaluate the effectiveness of fetal intervention for LUTO based on different severity of the disease, due to the very low quality of the studies according to GRADE guidelines. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - S A M Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - A M Abdelmagied
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Women's Health Hospital, Assiut University Hospitals, Assiut, Egypt
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| | - G Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - M D Kilby
- Centre for Women's and Children's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Ruano
- Mayo Clinic Fetal Diagnostic and Therapeutic Center, Mayo Clinic, Rochester, MN, USA
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Cruz-Martinez R, Martínez-Rodríguez M, Bermúdez-Rojas M, Magaña-Abarca C, Narvaez-Dominguez V, Rojas-Macedo A, Bautista-García N, Alcocer-Alcocer M. Fetal laser ablation of feeding artery of cystic lung lesions with systemic arterial blood supply. Ultrasound Obstet Gynecol 2017; 49:744-750. [PMID: 27363854 DOI: 10.1002/uog.16011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/30/2015] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the effectiveness of laser surgery in fetuses with a cystic lung lesion with systemic arterial blood supply (hybrid lung lesion) at risk of perinatal death. METHODS A cohort of five consecutive fetuses with a large hybrid lung lesion associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided fetal laser ablation of the feeding artery (FLAFA) before 32 weeks' gestation in a single tertiary national referral center in Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery. RESULTS FLAFA was performed successfully in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, dimensions in both lungs increased and fluid effusions resolved in all cases. All cases were delivered liveborn at term at a median gestational age of 39.6 (range, 38.0-39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three (60%) cases showed progressive regression of the entire lung mass and did not require postnatal surgery, whereas in two (40%) cases a progressive decrease in size of the mass was observed but a cystic portion of the lung mass persisted and postnatal lobectomy was required. CONCLUSION In fetuses with large hybrid lung lesions at risk of perinatal death, FLAFA is feasible and could improve survival and decrease the need for postnatal surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Cruz-Martinez
- National Fetal Medicine Research Network 'Fetal Medicine Mexico', Queretaro, Mexico
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico
| | - M Martínez-Rodríguez
- National Fetal Medicine Research Network 'Fetal Medicine Mexico', Queretaro, Mexico
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico
| | - M Bermúdez-Rojas
- National Fetal Medicine Research Network 'Fetal Medicine Mexico', Queretaro, Mexico
| | - C Magaña-Abarca
- National Fetal Medicine Research Network 'Fetal Medicine Mexico', Queretaro, Mexico
| | - V Narvaez-Dominguez
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico
| | - A Rojas-Macedo
- Department of Neonatology, Children's and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - N Bautista-García
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico
| | - M Alcocer-Alcocer
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico
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Kanaris C. Foetal surgery and using in utero therapies to reduce the degree of disability after birth. Could it be morally defensible or even morally required? Med Health Care Philos 2017; 20:131-146. [PMID: 27631407 DOI: 10.1007/s11019-016-9727-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In 2008 the Human Fertilisation and Embryology Act amendments made deliberately choosing to bring disability into the world, using assisted reproduction, a criminal offence. This paper considers whether the legal prohibition above, should influence other policy areas concerning the welfare of future children such as new possibilities presented by foetal surgery and in utero gene therapy. If we have legal duties to avoid disability in one context should this influence our avoidance of disability in this other context? This paper investigates whether the State might have a stake in wider promotion of practices to reduce the degree of disability in foetuses that will come to exist (as opposed to those that will be aborted). Not selecting for disability does not affect the welfare of any future individual, whereas treating in utero abnormalities can optimize the eventual child's welfare; antenatal interventions stand to improve clinical outcomes and welfare should that specific child be born. I explore why the State may want to intervene in the antenatal setting and to what extent, if at all; the State should implement these technologies. I argue that if the State is justified in intervening to outlaw the choosing to create disabled lives using assisted reproductive techniques, it is also justified in putting pressure on prospective parents to accept therapies in utero to help their child be born less disabled. However, I qualify this with the argument that the State is not justified in using force or the criminal law in this situation during pregnancy.
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Affiliation(s)
- Constantinos Kanaris
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK.
- The Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK.
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Vojtěch J, Hašlík L, Pock R, Běhávková K, Macková K, Hanulíková P, Heřman H, Krofta L. [Selective feticide in monochorionic twin pregnancies with discordant fetal anomalies: management and outcome]. Ceska Gynekol 2017; 82:345-350. [PMID: 29020780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN Prospective cohort study. SETTING Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period. There were 12 monochorionic diamniotic and one monochorionic monoamniotic twins. We encountered four cases of Twin Reversed Arterial Perfusion sequence (TRAP), six central nervous system lesions, two abdominal wall defects and one heterokaryotypic pregnancy with trisomy 13. In seven cases we performed bipolar cord occlusion, in four cases of TRAP sequence we performed radiofrequency ablation (RFA). We also performed laser photocoagulation of placental anastomoses in a case of gastroschisis complicated with twin-to-twin transfusion syndrome. One operation was unsuccessful for technical reasons - failing to perform amnioinfusion in a fetus with eventeration and anhydramnios. All procedures were performed in local anesthesia. Fetuses were born between 26 a 41 weeks of gestation (mean 35 weeks; 77% of fetuses were delivered after 32 weeks). Mean neonatal weight 2260 g. We encountered no intrauterine demise of a healthy fetus. CONCLUSION Patients with discordant fetal anomalies in monochorionic twins can be offered a selective feticide via bipolar umbilical cord occlusion or radiofrequency ablation that are proven to be safe and effective.
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Johnson MP, Bennett KA, Rand L, Burrows PK, Thom EA, Howell LJ, Farrell JA, Dabrowiak ME, Brock JW, Farmer DL, Adzick NS. The Management of Myelomeningocele Study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol 2016; 215:778.e1-778.e9. [PMID: 27496687 DOI: 10.1016/j.ajog.2016.07.052] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the data and safety monitoring committee and outcome data for 158 of the 183 randomized women published. OBJECTIVE In this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair. STUDY DESIGN Pregnancy outcomes were compared between the 2 surgery groups. For women who underwent prenatal surgery, antecedent demographic, surgical, and pregnancy complication risk factors were evaluated for the following outcomes: premature spontaneous membrane rupture ≤34 weeks 0 days (preterm premature rupture of membranes), spontaneous membrane rupture at any gestational age, preterm delivery at ≤34 weeks 0 days, nonintact hysterotomy (minimal uterine wall tissue between fetal membranes and uterine serosa, or partial or complete dehiscence at delivery), and chorioamniotic membrane separation. Risk factors were evaluated using χ2 and Wilcoxon tests and multivariable logistic regression. RESULTS A total of 183 women were randomized: 91 to prenatal and 92 to postnatal surgery groups. Analysis of the complete cohort confirmed initial findings: that prenatal surgery was associated with an increased risk for membrane separation, oligohydramnios, spontaneous membrane rupture, spontaneous onset of labor, and earlier gestational age at birth. In multivariable logistic regression of the prenatal surgery group adjusting for clinical center, earlier gestational age at surgery and chorioamniotic membrane separation were associated with increased risk of spontaneous membrane rupture (odds ratio, 1.49; 95% confidence interval, 1.01-2.22; and odds ratio, 2.96, 95% confidence interval, 1.05-8.35, respectively). Oligohydramnios was associated with an increased risk of subsequent preterm delivery (odds ratio, 9.21; 95% confidence interval, 2.19-38.78). Nulliparity was a risk factor for nonintact hysterotomy (odds ratio, 3.68; 95% confidence interval, 1.35-10.05). CONCLUSION Despite the confirmed benefits of prenatal surgery, considerable maternal and fetal risk exists compared with postnatal repair. Early gestational age at surgery and development of chorioamniotic membrane separation are risk factors for ruptured membranes. Oligohydramnios is a risk factor for preterm delivery and nulliparity is a risk factor for nonintact hysterotomy at delivery.
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Affiliation(s)
- Mark P Johnson
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | | | - Larry Rand
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | - Pamela K Burrows
- George Washington University Biostatistics Center, Washington, DC
| | - Elizabeth A Thom
- George Washington University Biostatistics Center, Washington, DC
| | - Lori J Howell
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jody A Farrell
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | | | - John W Brock
- Vanderbilt University Medical Center, Nashville, TN
| | - Diana L Farmer
- University of California San Francisco Benioff Children's Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA
| | - N Scott Adzick
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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41
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Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, Espinoza J, Safdar A, Moaddab A, Meyer N, Cass DL, Olutoye OO, Olutoye OA, Welty S, Roth DR, Braun MC, Belfort MA. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol 2016; 48:476-482. [PMID: 26690832 DOI: 10.1002/uog.15844] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 08/13/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported. RESULTS Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival. CONCLUSIONS Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. ,
| | - N Sananes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - C Wilson
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - J Au
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - C J Koh
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - P Gargollo
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A Safdar
- Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - A Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - N Meyer
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - D L Cass
- Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - O O Olutoye
- Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - O A Olutoye
- Department of Anesthesiology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - S Welty
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - D R Roth
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - M C Braun
- Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
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42
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Moreira de Sá RA, Nassar de Carvalho PR, Kurjak A, Adra A, Dayyabu AL, Ebrashy A, Pooh R, Sen C, Wataganara T, Stanojevic M. Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM). J Perinat Med 2016; 44:737-743. [PMID: 26124046 DOI: 10.1515/jpm-2015-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.
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43
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Gardiner HM, Kovacevic A, Tulzer G, Sarkola T, Herberg U, Dangel J, Öhman A, Bartrons J, Carvalho JS, Jicinska H, Fesslova V, Averiss I, Mellander M. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol 2016; 48:373-381. [PMID: 26843026 DOI: 10.1002/uog.15876] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 12/22/2015] [Revised: 01/22/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life remains poorly defined. The primary aim of this study was to describe the natural history of fetal aortic stenosis, and a secondary aim was to test previously published criteria designed to identify cases of emerging HLHS with the potential for a biventricular (BV) outcome after FV. METHODS From a European multicenter retrospective study of 214 fetuses with aortic stenosis (2005-2012), 107 fetuses in ongoing pregnancies that did not undergo FV were included in this study and their natural history was reported. We examined longitudinal changes in Z-scores of aortic and mitral valve and left ventricular dimensions and documented direction of flow across the foramen ovale and aortic arch, and mitral valve inflow pattern and any gestational changes. Data were used to identify fetuses satisfying the Boston criteria for emerging HLHS and estimate the proportion of these that would have been ideal FV candidates. We applied the threshold score whereby a score of 1 was assigned to fetuses for each Z-score meeting the following criteria: left ventricular length and width > 0; mitral valve diameter > -2; aortic valve diameter > -3.5; and pressure gradient across either the mitral or aortic valve > 20 mmHg. We compared the predicted circulation with known survival and final postnatal circulation (BV, UV or conversion from BV to UV). RESULTS Among the 107 ongoing pregnancies there were eight spontaneous fetal deaths and 99 livebirths. Five were lost to follow-up, five had comfort care and four had mild aortic stenosis not requiring intervention. There was intention-to-treat in these 85 newborns but five died prior to surgery, before circulation could be determined, and thus 80 underwent postnatal procedures with 44 BV, 29 UV and seven BV-to-UV circulatory outcomes. Of newborns with intention-to-treat, 69/85 (81%) survived ≥ 30 days. Survival at median 6 years was superior in cases with BV circulation (P = 0.041). Those with a postnatal UV circulation showed a trend towards smaller aortic valve diameters at first scan than did the BV cohort (P = 0.076), but aortic valve growth velocities were similar in both cohorts to term. In contrast, the mitral valve diameter was significantly smaller at first scan in those with postnatal UV outcomes (P = 0.004) and its growth velocity (P = 0.008), in common with the left ventricular inlet length (P = 0.004) and width (P = 0.002), were reduced significantly by term in fetuses with UV compared with BV outcome. Fetal data, recorded before 30 completed gestational weeks, from 70 treated neonates were evaluated to identify emerging HLHS. Forty-four had moderate or severe left ventricular depression and 38 of these had retrograde flow in the aortic arch and two had left-to-right flow at atrial level and reversed a-waves in the pulmonary veins. Thus 40 neonates met the criteria for emerging HLHS and BV circulation was documented in 13 (33%). Of these 40 cases, 12 (30%) had a threshold score of 4 or 5, of which five (42%) had BV circulation without fetal intervention. CONCLUSIONS The natural history in our cohort of fetuses with aortic stenosis and known outcomes shows that a substantial proportion of fetuses meeting the criteria for emerging HLHS, with or without favorable selection criteria for FV, had a sustained BV circulation without fetal intervention. This indicates that further work is needed to refine the selection criteria to offer appropriate therapy to fetuses with aortic stenosis. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H M Gardiner
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - A Kovacevic
- Department of Paediatric and Congenital Cardiology, University of Heidelberg, Heidelberg, Germany
| | - G Tulzer
- Department of Paediatric Cardiology, Children's Heart Centre, Linz, Austria
| | - T Sarkola
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - U Herberg
- Department of Paediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - J Dangel
- Perinatal Cardiology Clinic, 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - A Öhman
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Bartrons
- Department of Paediatric Cardiology, Sant Joan de Déu, Barcelona, Spain
| | - J S Carvalho
- Department of Paediatric and Congenital Cardiology, Royal Brompton and Harefield Hospital, NHS Trust, and Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK
| | - H Jicinska
- University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - V Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCSS, Milan, Italy
| | - I Averiss
- The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - M Mellander
- Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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44
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Abstract
OBJECTIVES: The purpose of this study was to examine the effects of profound auditory deprivation and its treatment by cochlear implantation and stimulation on the metabolic activity of the central auditory system in fetal sheep. METHODS: Six ovine fetuses at 85% to 90% gestation were bilaterally deafened by kanamycin perfusion and unilaterally implanted with cochlear electrode arrays. Half of the implanted animals were stimulated with an extrauterine sound processor, and half were not. Four animals served as hearing controls. One week postoperatively, central nervous system metabolic activity was evaluated in ambient laboratory noise by quantitative autoradiography using 14C-deoxyglucose. RESULTS: Kanamycin perfusion deafened all treated animals as verified by auditory brainstem response and scanning electron microscopy. Glucose utilization in the inferior colliculus was markedly lower in deafened and unstimulated animals relative to hearing controls. Glucose utilization in implanted-stimulated animals was similar to normal controls. CONCLUSIONS: Changes in central auditory system metabolic activity associated with congenital deafness may be minimized by prompt auditory habilitation.
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MESH Headings
- Animals
- Anti-Bacterial Agents
- Auditory Diseases, Central/chemically induced
- Auditory Diseases, Central/congenital
- Auditory Diseases, Central/diagnosis
- Auditory Diseases, Central/metabolism
- Auditory Diseases, Central/surgery
- Autoradiography
- Brain Chemistry
- Carbon Radioisotopes/metabolism
- Cochlear Implantation
- Disease Models, Animal
- Evoked Potentials, Auditory, Brain Stem
- Fetal Diseases/diagnosis
- Fetal Diseases/metabolism
- Fetal Diseases/surgery
- Gestational Age
- Humans
- Infant, Newborn
- Kanamycin
- Microscopy, Electron, Scanning
- Neonatal Screening
- Prenatal Care/methods
- Sheep
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Affiliation(s)
- Patrick J Antonelli
- Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.
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45
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Belfort MA, Shamshirsaz AA, Whitehead WE, Ball R, Silver R, Ruano R, Espinoza J, Mann DG, McCullough L, Chervenak F. Unusual pleuroamniotic shunt complication managed using a two-port in-CO2 fetoscopic technique: technical and ethical considerations. Ultrasound Obstet Gynecol 2016; 47:123-124. [PMID: 26183219 DOI: 10.1002/uog.14947] [Citation(s) in RCA: 4] [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: 05/06/2015] [Revised: 06/02/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
Affiliation(s)
- M A Belfort
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, 6651 Main Street, Houston, TX, 77030, USA
| | - A A Shamshirsaz
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, 6651 Main Street, Houston, TX, 77030, USA
| | - W E Whitehead
- Baylor College of Medicine, Department Neurosurgery, Texas Children's Hospital Fetal Center, Houston, TX, USA
| | - R Ball
- Department of Obstetrics and Gynecology, St Marks Hospital, Salt Lake City, UT, USA
| | - R Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - R Ruano
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, 6651 Main Street, Houston, TX, 77030, USA
| | - J Espinoza
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, 6651 Main Street, Houston, TX, 77030, USA
| | - D G Mann
- Baylor College of Medicine, Department of Anesthesiology, Texas Children's Hospital Fetal Center, Houston, TX, USA
| | - L McCullough
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, 6651 Main Street, Houston, TX, 77030, USA
| | - F Chervenak
- Department of Obstetrics and Gynecology, Weill-Cornell Medical College, New York, NY, USA
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46
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Tul N, Bricelj K, Ravnik D, Diehl W, Hecher K. Successful laser treatment in monochorionic quadruplets affected by fetofetal transfusion syndrome. Ultrasound Obstet Gynecol 2015; 46:749-750. [PMID: 26411739 DOI: 10.1002/uog.15765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N Tul
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center, Ljubljana, Slovenia
| | - K Bricelj
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center, Ljubljana, Slovenia
| | - D Ravnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - W Diehl
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Germany
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47
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Smith-Harrison LI, Hougen HY, Timberlake MD, Corbett ST. Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol 2015; 11:341-7. [PMID: 26441047 DOI: 10.1016/j.jpurol.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/19/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Since the early 1980s with the inception of fetal intervention for obstructive uropathy, there have been creative attempts to improve both perinatal and long-term outcomes. Despite advances in technology and an improved understanding of lower urinary tract obstruction (LUTO) in the fetus, the results for these therapeutic interventions remain guarded and the long-term renal morbidity among survivors remains problematic. RECENT FINDINGS Fetal LUTO represents a range of disorders but the most common of these is posterior urethral valves (PUVs). Selection criteria for candidates of possible intervention have improved with our understanding of fetal renal physiology. Serial urinalysis has marginally improved our ability to predict those that may ultimately respond to treatment [1,2], but the potential in the development of biomarkers for renal development or maldevelopment holds greater promise [3]. Advancements in fetal surgery may result in less fetal and maternal morbidity, but limited long-term improvement in outcomes highlights the controversial nature of the various interventions [4-10]. We must counsel families that fetal surgery offers hope but we cannot allow them to hold unrealistic expectations for cure. SUMMARY In appropriately selected fetuses, intervention may improve perinatal survival but not without risk to mother and fetus. Long-term renal outcomes remain problematic amongst survivors. In the case of PUV, postnatal primary valve ablation remains the cornerstone of treatment for nephron preservation; however, our ability to mimic these results in the prenatal population remains poor [11]. Disease severity has likely predetermined those that will survive through the perinatal period with or without intervention. Nonetheless, our drive to assess and manage fetal obstructive uropathy perseveres so that we may ultimately relieve obstruction and preserve renal and lung function. We must maintain optimism that continued advances will ultimately improve outcomes, but also be realistic with our current expectations. This paper reviews the status of current in utero interventions and outcomes.
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Affiliation(s)
- L I Smith-Harrison
- University of Virginia Children's Hospital/University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Helen Y Hougen
- University of Virginia Children's Hospital/University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Matthew D Timberlake
- University of Virginia Children's Hospital/University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Sean T Corbett
- University of Virginia Children's Hospital/University of Virginia School of Medicine, Charlottesville, VA, USA.
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48
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Cruz-Martinez R, Méndez A, Dueñas-Riaño J, Ordorica-Flores R, Nieto-Zermeño J, Malagón-Salazar P, Medina-Noyola C, Rebolledo-Fernández C. Fetal laser surgery prevents fetal death and avoids the need for neonatal sequestrectomy in cases with bronchopulmonary sequestration. Ultrasound Obstet Gynecol 2015; 46:627-628. [PMID: 26046453 DOI: 10.1002/uog.14921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 06/04/2023]
Affiliation(s)
- R Cruz-Martinez
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital, Querétaro, Mexico
- Unidad de Investigación en Neurodesarrollo 'Dr Augusto Fernández Guardiola', Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, México
- Fetal Medicine Mexico Research Group, Mexico
| | - A Méndez
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital, Querétaro, Mexico
- Unidad de Investigación en Neurodesarrollo 'Dr Augusto Fernández Guardiola', Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, México
- Fetal Medicine Mexico Research Group, Mexico
| | | | - R Ordorica-Flores
- Department of Pediatric Surgery, Hospital Infantil de Mexico 'Dr. Federico Gómez', Mexico City, Mexico
| | - J Nieto-Zermeño
- Department of Pediatric Surgery, Hospital Infantil de Mexico 'Dr. Federico Gómez', Mexico City, Mexico
| | - P Malagón-Salazar
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital, Querétaro, Mexico
- Unidad de Investigación en Neurodesarrollo 'Dr Augusto Fernández Guardiola', Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, México
| | - C Medina-Noyola
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital, Querétaro, Mexico
- Unidad de Investigación en Neurodesarrollo 'Dr Augusto Fernández Guardiola', Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, México
| | - C Rebolledo-Fernández
- Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital, Querétaro, Mexico
- Unidad de Investigación en Neurodesarrollo 'Dr Augusto Fernández Guardiola', Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, México
- Fetal Medicine Mexico Research Group, Mexico
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49
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Hosseinzadeh P, Shamshirsaz AA, Cass DL, Espinoza J, Lee W, Salmanian B, Ruano R, Belfort MA. Fetoscopic laser ablation of vasa previa in pregnancy complicated by giant fetal cervical lymphatic malformation. Ultrasound Obstet Gynecol 2015; 46:507-508. [PMID: 25612246 DOI: 10.1002/uog.14796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 06/04/2023]
Affiliation(s)
- P Hosseinzadeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - D L Cass
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - W Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B Salmanian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R Ruano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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50
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Simoens E, Hindryckx A, Moerman P, Claus F, De Catte L. Termination of pregnancy for renal malformations. Pediatr Nephrol 2015; 30:1443-9. [PMID: 25820996 DOI: 10.1007/s00467-015-3085-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND We studied the correlation between prenatal diagnosis and postmortem investigations in pregnancies terminated for renal malformations. METHODS Over a 5-year period, 77 cases of termination of pregnancy (TOP) for renal malformations were reviewed. Chromosomal anomalies (n = 9) and cases without conventional or virtual autopsy were excluded (n = 15). In 53 cases, prenatal ultrasound diagnosis and conventional autopsy findings were compared. In addition, we compared the accuracy of conventional and virtual autopsy findings in 17 cases. RESULTS Full agreement was observed in 60.4% (32/53) of cases. In 26.4% (14/53) of the cases, the presence of additional malformations did not alter the final diagnosis. However, in 11.3% (6/53) the final diagnosis was adjusted because of major additional findings. One case showed a total disagreement. Conventional and virtual autopsy were in full agreement in 52.9% (9/17). Postmortem magnetic resonance imaging (MRI) description and detection of malformations was less complete and failed to correctly diagnose 5/17 cases (29.4%). In 17.6% (3/17) of the cases, postmortem MRI revealed malformations not confirmed by conventional autopsy. CONCLUSIONS A high correlation between prenatal ultrasound and postmortem investigations was observed. Conventional autopsy remains the gold standard to reveal additional major and minor malformations, leading to a correct final diagnosis. The added value of virtual necropsy for renal pathology was limited.
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Affiliation(s)
- Eva Simoens
- Department of Obstetrics and Gynaecology, University Hospitals Gasthuisberg - KU Leuven, Herestraat 49, 3000, Leuven, Belgium,
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