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Fetal and surgery

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https://www.readbyqxmd.com/read/29240893/risk-and-reputation-obstetricians-cesareans-and-consent
#1
Jacqueline H Wolf
When physicians performed cesarean sections in the nineteenth century, they customarily sought agreement from all present before proceeding. In contrast, after the introduction of electronic fetal monitoring in the late 1960s, obstetricians obtained permission for a cesarean by offering a choice that ensured consent-give birth by cesarean or give birth vaginally to a damaged or dead baby. This article argues that the manner in which physicians obtained consent for cesareans in the nineteenth century was one factor that kept the cesarean rate low, while the manner in which physicians obtained consent in the late twentieth and early twenty-first centuries was one factor driving up the cesarean rate...
December 12, 2017: Journal of the History of Medicine and Allied Sciences
https://www.readbyqxmd.com/read/29239485/comparison-of-umbilical-cord-occlusion-methods-radiofrequency-ablation-versus-laser-photocoagulation
#2
Mira Abdel-Sattar, Andrew H Chon, Arlyn Llanes, Lisa M Korst, Joseph G Ouzounian, Ramen H Chmait
OBJECTIVE: To compare outcomes between two umbilical cord occlusion (UCO) methods: radiofrequency ablation (RFA) versus fetoscopic-guided laser photocoagulation. METHODS: Retrospective study of all monochorionic diamniotic multiple gestations that underwent UCO with RFA (preferred after 2014) or laser (preferred before 2014). In bivariate analysis, patients treated with RFA were compared to laser. Risk factors for intrauterine fetal demise (IUFD) and 30-day survival of the co-twin were identified, and multiple logistic models were fitted to examine whether the UCO method was associated with these outcomes...
December 14, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29237141/lessons-from-the-barn-to-the-operating-suite-a-comprehensive-review-of-animal-models-for-fetal-surgery
#3
Sandra K Kabagambe, Chelsey J Lee, Laura F Goodman, Y Julia Chen, Melissa A Vanover, Diana L Farmer
The International Fetal Medicine and Surgery Society was created in 1982 and proposed guidelines for fetal interventions that required demonstrations of the safety and feasibility of intended interventions in animal models prior to application in humans. Because of their short gestation and low cost, small animal models are useful in early investigation of fetal strategies. However, owing to the anatomic and physiologic differences between small animals and humans, repeated studies in large animal models are usually needed to facilitate translation to humans...
December 13, 2017: Annual Review of Animal Biosciences
https://www.readbyqxmd.com/read/29221765/advances-in-fetal-echocardiography
#4
REVIEW
Helena M Gardiner
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the 'five-transverse view' protocol...
December 5, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29221334/minimally-invasive-multi-disciplinary-approach-for-surgical-management-of-a-mediastinal-congenital-bronchogenic-cyst-in-a-6-month-old-infant
#5
Xiao-Hua Li, Tao Zhang, Sheng Wang, Biao-Chuan He, Xue-Ning Yang, Wen-Zhao Zhong, Ji-Mei Chen
We present a case of prenatal diagnosis of a mediastinal cyst by ultrasound, confirmed during infancy through computed tomography (CT) and magnetic resonance imaging (MRI). A 6-month-old male infant was admitted to the hospital. A mid-mediastinal cyst was detected through a province-wide fetal ultrasonography screening program. During the infancy stage, the CT scan and the MRI confirmed the finding of a mediastinal cyst. Based on the findings on prenatal ultrasonography and postnatal imaging studies (CT, MRI), a benign mediastinal cyst was suspected...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29215525/low-fidelity-simulator-for-the-standardized-training-of-fetoscopic-meningomyelocele-repair
#6
Michael A Belfort, William E Whitehead, Andrey Bednov, Alireza A Shamshirsaz
BACKGROUND: Fetoscopic meningomyelocele repair in a gas-filled uterus is a new technique performed in very few centers. There are few opportunities as well as ethical prohibitions on the initial development and subsequent refinement of innovative fetal surgery techniques in humans, and using an animal model is both very expensive and logistically difficult. METHOD: We developed a low-fidelity endoscopic fetal surgery simulation using a plastic doll and pieces of chicken breast to simulate a fetal meningomyelocele, and a polyurethane ball to simulate a gas-filled uterus, along with a standard endoscopy system and instruments...
December 4, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29212591/-pregnancy-after-bariatric-surgery
#7
Mette Mandrup Kjær, Lise Lotte Torvin-Andersen, Peter Dam, Dorte Møller Jensen, Jeanette Lauenborg, Louise Laage Stentebjerg, René Klinkeby Støving, Kristina Martha Renault
This is a review of the recommendations regarding pregnancy after bariatric surgery from the Danish Society of Obstetrics and Gynaecology. The risk of vitamin/mineral deficiencies should be emphasized and checked with blood samples. Measurements of fetal growth should be offered at gestational age 28 and 34 as a supplement to the standard prenatal procedures because of the increased risk of intrauterine growth retardation. Because of persistent obesity there is still an increased risk of hypertension and diabetes mellitus...
December 4, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29207383/thoracic-changes-after-full-laser-ablation-of-the-feeding-artery-in-fetuses-with-bronchopulmonary-sequestration
#8
Rogelio Cruz-Martínez, Belén Nieto-Castro, Miguel Martínez-Rodríguez, Alma Gámez-Varela, Edgar Ahumada-Angulo, Jonahtan Luna-García, Maria José Pineda-Pérez, Carlos Rebolledo-Fernández
OBJECTIVE: To assess longitudinal intrathoracic changes after fetal laser surgery in fetuses with bronchopulmonary sequestration (BPS) with hydrops and/or hydrothorax. STUDY DESIGN: The presence of intrafetal fluid effusions, the lung mass volume ratio (congenital pulmonary airway malformation volume ratio [CVR]), and the observed/expected lung-to-head circumference ratio (O/E-LHR) of both lungs were evaluated in a cohort of BPS fetuses with hydrops and/or hydrothorax treated with full laser ablation of the feeding artery (FLAFA)...
December 6, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29207382/incidental-septostomy-after-laser-surgery-for-twin-twin-transfusion-syndrome-perinatal-outcomes-and-antenatal-management
#9
Brian J Gordon, Andrew H Chon, Lisa M Korst, Arlyn Llanes, David A Miller, Ramen H Chmait
INTRODUCTION: Incidental septostomy, or inadvertent perforation of the twins' dividing membranes, can create a functional monoamniotic twin pregnancy. Our aim was to describe the perinatal outcomes and antenatal management of patients with incidental septostomy after laser surgery for twin-twin transfusion syndrome (TTTS). MATERIALS AND METHODS: Monochorionic diamniotic multiple gestations with a gestational age (GA) between 16 and 26 weeks that underwent laser surgery from March 2006 to December 2015 were studied retrospectively...
December 5, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29201439/management-of-an-acute-ischemic-stroke-during-thrombolytic-treatment-in-a-pregnant-patient-with-prosthetic-valve-thrombosis
#10
Macit Kalçık, Mahmut Yesin, Emrah Bayam, Mustafa Ozan Gürsoy, Ahmet Güner, Sabahattin Gündüz, Mehmet Özkan
Prosthetic valve thrombosis (PVT) is a life-threatening complication in pregnant women with mechanical prosthetic heart valves. Thrombolytic therapy (TT) has evolved as an effective treatment alternative to surgery, which is associated with very high maternal and fetal mortality and morbidity in these patients. Acute ischemic stroke may rarely occur during TT for PVT. Here, we present a pregnant patient who was complicated with cerebral thromboembolism during TT for PVT and successfully managed with continuation of TT...
September 2017: Interventional Medicine & Applied Science
https://www.readbyqxmd.com/read/29198999/society-for-fetal-urology-classification-versus-urinary-tract-dilation-grading-systems-for-prognostication-in-prenatal-hydronephrosis-a-time-to-resolution-analysis
#11
Luis H Braga, Melissa McGrath, Forough Farrokhyar, Kizanee Jegatheeswaran, Armando J Lorenzo
PURPOSE: The Urinary Tract Dilation (UTD) grading system for prenatal hydronephrosis (HN) was introduced to address potential shortcomings of the SFU classification. HN resolution is an important patient outcome and frequently discussed during family counselling. Herein we compare these two grading systems and their ability to predict time to HN resolution. MATERIALS AND METHODS: 855 prospectively screened patients between 2009-2015 with prenatal HN due to uretero-pelvic junction-like, primary non-refluxing megaureter or vesico-ureteral reflux; with 454 being excluded due to surgeries, late referrals, absence of postnatal dilation and presence of other anomalies, resulting in 401 eligible patients to be included for analyses...
November 30, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29189693/practice-bulletin-no-187-neural-tube-defects
#12
(no author information available yet)
Neural tube defects (NTDs) are congenital structural abnormalities of the central nervous system and vertebral column. Neural tube defects may occur as an isolated malformation, in combination with other malformations, as part of a genetic syndrome, or as a result of teratogenic exposure (1). Neural tube defects are the second-most-common major congenital anomaly (2) after cardiac malformations, and their prevalence varies by geographic region, race, and environmental factors (3). Outcomes and disabilities depend on level and extent of lesion; for instance, anencephaly is incompatible with life but most infants with spina bifida will survive after surgical repair (4)...
December 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29189691/practice-bulletin-no-187-summary-neural-tube-defects
#13
(no author information available yet)
Neural tube defects (NTDs) are congenital structural abnormalities of the central nervous system and vertebral column. Neural tube defects may occur as an isolated malformation, in combination with other malformations, as part of a genetic syndrome, or as a result of teratogenic exposure (1). Neural tube defects are the second-most-common major congenital anomaly (2) after cardiac malformations, and their prevalence varies by geographic region, race, and environmental factors (3). Outcomes and disabilities depend on level and extent of lesion; for instance, anencephaly is incompatible with life but most infants with spina bifida will survive after surgical repair (4)...
December 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29185370/effect-of-nicotine-on-placental-ischemia-induced-complement-activation-and-hypertension-in-the-rat
#14
Connor F Laule, Cameron R Wing, Evan J Odean, Jacob A Wilcox, Jeffrey S Gilbert, Jean F Regal
Preeclampsia is a pregnancy-specific condition manifested by new-onset maternal hypertension with systemic inflammation, including increased innate immune system complement activation. While exact pathophysiology is unknown, evidence suggests that inadequate spiral artery invasion and resulting utero-placental insufficiency is the initiating event. Cigarette smoking during pregnancy decreases the risk of preeclampsia. Nicotine, a major component of cigarettes, stimulates the efferent cholinergic anti-inflammatory pathway through peripherally expressed nicotinic acetylcholine receptors (nAChR) and is known to attenuate ischemia-reperfusion injury in kidney and liver...
December 2017: Journal of Immunotoxicology
https://www.readbyqxmd.com/read/29181994/urachal-remnant-causing-umbilical-in-drawing-during-micturition
#15
A J Martin, L McDonald, M Gopal
The urachus is a vestigial remnant of the allantois, which is normally obliterated during fetal life to become the median umbilical ligament, which runs between the urinary bladder and umbilicus in adults. Failure of obliteration leaves a tubular urachal remnant, which may present with disease. We report a unique case of a urachal remnant causing umbilical pain and in-drawing on micturition in a nine-year-old boy. There was no urine discharge from the umbilicus and in-drawing did not occur on defecation. His urinary stream was normal...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29180341/-surgical-management-of-pregnancy-associated-acute-stanford-type-a-aortic-dissection-analysis-of-5-cases
#16
Xin Li, Hong-Yu Zhang, Feng-Zhen Han, Chang-Jiang Yu, Xiao-Ping Fan, Rui-Xin Fan, Jian Zhuang
OBJECTIVE: To explore the diagnosis and treatment of pregnancy-associated acute Stanford type A aortic dissection to improve the maternal and fetal outcomes. METHODS: We analyzed the perioperative data of 5 pregnant women with acute Stanford type A aortic dissection treated between June, 2009 and February, 2017. RESULTS: The median age of the women was 30 years (range, 22-34 years) with gestational weeks of 23-38 weeks upon diagnosis. All the 5 patients received surgical interventions...
November 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/29172821/risk-of-donor-demise-after-laser-therapy-for-twin-twin-transfusion-when-complicated-by-growth-discordance-and-abnormal-umbilical-artery-doppler-findings
#17
Matthew M Finneran, Megan A Templin, Courtney D Stephenson
OBJECTIVE: To investigate the natural course of abnormal umbilical artery Doppler (UAD) findings in donor fetuses after laser surgery and the prognostic significance of resolution, persistence, or new onset UAD abnormalities with and without the presence of preoperative growth discordance. STUDY DESIGN: Retrospective cohort study of all monochorionic-diamniotic multi-fetal gestations diagnosed with twin-twin transfusion syndrome (TTTS) undergoing laser surgery at a single large metropolitan referral center from 2010-2016...
November 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29169875/current-and-future-antenatal-management-of-isolated-congenital-diaphragmatic-hernia
#18
REVIEW
Francesca Maria Russo, Paolo De Coppi, Karel Allegaert, Jaan Toelen, Lennart van der Veeken, George Attilakos, Mary Patrice Eastwood, Anna Louise David, Jan Deprest
Congenital diaphragmatic hernia is surgically correctable, yet the poor lung development determines mortality and morbidity. In isolated cases the outcome may be predicted prenatally by medical imaging. Cases with a poor prognosis could be treated before birth. However, prenatal modulation of lung development remains experimental. Fetoscopic endoluminal tracheal occlusion triggers lung growth and is currently being evaluated in a global clinical trial. Prenatal transplacental sildenafil administration may in due course be a therapeutic approach, reducing the occurrence of persistent pulmonary hypertension, either alone or in combination with fetal surgery...
November 21, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29167317/rodent-vertical-sleeve-gastrectomy-alters-maternal-immune-health-and-feto-placental-development
#19
Redin A Spann, Wiiliam J Lawson, Gene L Bidwell, C Austin Zamarripa, Rodrigo O Maranon, Sibali Bandyopadhyay, Erin R Taylor, Jane F Reckelhoff, Michael R Garrett, Bernadette E Grayson
Bariatric surgery is increasingly employed to improve fertility and reduce obesity related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy...
November 22, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/29161808/renal-outcome-of-congenital-anomalies-of-the-kidney-and-urinary-tract-system-a-singe-center-retrospective-study
#20
Rahime Renda
BACKGROUND: Congenital anomalies of the kidney and urinary tract (CAKUT) have been defined in 20 to 50% of all fetal anomalies. The aim of this study was to determine the demographic and clinical characteristics of such patients, as well as to describe the outcome and risk factors that affect the prognosis. METHODS: The analysis investigated retrospective data from 303 patients diagnosed with CAKUT between January 2015 and April 2017. Demographic data, clinical history, diagnosis, investigations, disease outcomes, and treatment procedures were evaluated...
November 21, 2017: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
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