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fetal surgery

Uri P Dior, Ricardo Palma-Dias, Karen L Reidy, Claudia Cheng, Martin Healey
STUDY OBJECTIVE: To describe the incidence, management, complications and define risk factors for conversion from medical to surgical treatment of Cesarean Scar Pregnancies (CSP). DESIGN: A retrospective clinical study (Canadian Task Force classification II-3). SETTING: A tertiary medical center. PATIENTS: All patients who were admitted and treated for CSP between 2008 and 2016. INTERVENTIONS: The cohort was divided according to management; demographic, clinical and sonographic data were collected...
September 19, 2018: Journal of Minimally Invasive Gynecology
Sasha Skinner, Philip Dekoninck, Kelly Crossley, Benjamin Amberg, Jan Deprest, Stuart Hooper, Ryan Hodges
Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2 ) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra-amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocoele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery...
September 20, 2018: Prenatal Diagnosis
U D Nagaraj, K S Bierbrauer, C B Stevenson, J L Peiro, F Y Lim, B Zhang, B M Kline-Fath
BACKGROUND AND PURPOSE: Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population. MATERIALS AND METHODS: A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging...
September 20, 2018: AJNR. American Journal of Neuroradiology
Agustín Silberberg, Josefina Robetto, Magdalena Grillo
Intrauterine surgery shows that the prognosis of neonates with myelomeningocele (MMC) has improved, both in survival and in quality of life. In order to study the current efficacy of intrauterine surgery for MMC and to make an ethical analysis of its proportionality, we conducted a PubMed search using the keywords "myelomeningocele", "intrauterine surgery", "MOMS", and "trial". Thirty-eight articles were found. The literature investigated the risks and benefits of intrauterine surgery based on the physiological parameters of MMC...
September 20, 2018: New Bioethics: a Multidisciplinary Journal of Biotechnology and the Body
Gemma B Scholes, Diana Zannino, Joshua Y Kausman, Michael M H Cheung
BACKGROUND: It is known that the heart is not the only organ affected in congenital heart disease (CHD); there is growth restriction of both the brain and the whole body. The protective mechanism of "the brain-sparing phenomenon" re-directs blood flow toward the growing brain in fetuses with CHD. We hypothesized that these changes would result in impaired fetal kidney growth. METHODS: The preoperative ultrasound measurements of kidney length were obtained retrospectively from 452 neonates requiring surgery for CHD...
September 11, 2018: Pediatric Research
Toshihiko Watanabe, Michinobu Ohno, Kazunori Tahara, Kotaro Tomonaga, Yasushi Fuchimoto, Akihiro Fujino, Tomoro Hishiki, Keiko Tsukamoto, Yushi Ito, Rika Sugibayashi, Seiji Wada, Haruhiko Sago, Masataka Higuchi, Kazuteru Kawasaki, Takako Yoshioka, Yutaka Kanamori
BACKGROUND/PURPOSE: Differences in clinical features between congenital pulmonary airway malformation (CPAM) and bronchial atresia (BA) have not yet been clearly described. METHODS: We retrospectively reviewed 112 patients with a pathological diagnosis of CPAM or BA. The clinical parameters were statistically analyzed between these diseases. RESULTS: Seventy-one patients received prenatal diagnosis and 41 received postnatal diagnosis. The percentage of prenatal diagnosis was significantly higher in CPAM patients (84% vs 50%, p < 0...
September 1, 2018: Journal of Pediatric Surgery
Luca Mazzone, Ueli Moehrlen, Barbara Casanova, Samira Ryf, Nicole Ochsenbein-Kölble, Roland Zimmermann, Franziska Kraehenmann, Martin Meuli
OBJECTIVE: The majority of patients counseled for prenatal open spina bifida repair (SBR) do not undergo fetal surgery. The aim of this study was to analyze the reasons for this phenomenon. MATERIALS AND METHODS: The data of the first 160 patients seeking counseling or referred to the Zurich Center for Fetal Diagnosis and Therapy for prenatal SBR between December 2010 and March 2017 were retrospectively analyzed. RESULTS: A total of 104 (65%) patients did not undergo prenatal SBR...
September 11, 2018: Fetal Diagnosis and Therapy
Victoria M Stoll, Nigel E Drury, Sara Thorne, Tara Selman, Paul Clift, Hsu Chong, Peter J Thompson, R Katie Morris, Lucy E Hudsmith
Importance: A growing number of women are approaching childbearing age after arterial switch surgery for transposition of the great arteries. Prepregnancy counseling requires updated knowledge of the additional cardiovascular risks pregnancy poses for this cohort of women and the potential effect on their offspring; however, to our knowledge, this information is currently unknown. Objective: To determine the pregnancy outcomes of women with transposition of the great arteries after an arterial switch operation, as well as the outcomes of their offspring...
September 5, 2018: JAMA Cardiology
Chang-Zhong Shao, Kun-Peng Xia
Sevoflurane has been commonly utilized in nonobstetric surgeries in pregnant women, and its impacts on fetal brain are still not completely known. Ectopic NR4A2 expression has been reported to be related with familial Parkinson disease, and through dual luciferase we found that NR4A2 is a target gene of microRNA-183 (miR-183). We proposed a hypothesis that miR-183 may participate in the process by targeting NR4A2 in neurons after sevoflurane anesthesia. To verify the effect of sevoflurane on hippocampal neural stem cells (NSCs) proliferation and differentiation, we conducted EdU assay and immunofluorescence staining...
September 7, 2018: Journal of Cellular Physiology
Yuichiro Takahashi, Haruhiko Sago, Keisuke Ishii, Takeshi Murakoshi, Jun Murotsuki, Masahiko Nakata
AIM: Since fetal therapy has been newly developed, objective evaluation of adverse events (AE), all harmful events that are not always related to the procedures, has not yet been adequately reported. We established new terminology and tried to re-evaluate it based on the Japanese prospective thoraco-amniotic shunting (TAS) study. METHODS: From the literature, all complications that occurred with all fetal therapies were identified as a basis for developing the terminology...
September 6, 2018: Journal of Obstetrics and Gynaecology Research
Emmanuel Rault, Audrey Lacalm, Mona Massoud, Jérome Massardier, Federico Di Rocco, Pascal Gaucherand, Laurent Guibaud
OBJECTIVE: To describe the different prenatal imaging patterns related to primary aqueduct obstruction throughout pregnancy and their impact on prenatal counseling. METHOD: Retrospective review of consecutive prenatal cases of isolated aqueduct obstruction diagnosed over a seven-year period (2010-2016). Prenatal imaging findings, postnatal imaging, pathological data and postnatal outcome, were analyzed. RESULTS: Twelve cases were included...
August 10, 2018: European Journal of Paediatric Neurology: EJPN
Jan Van Looveren, Arnout Vael, Nick Ideler, Hedwig Sillen, Danny Mathysen, Marie-José Tassignon
PURPOSE: To report the status of Berger space in pediatric cataract cases and the influence of anterior vitreolenticular interface dysgenesis during primary posterior continuous curvilinear capsulorhexis (PCCC). SETTING: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. DESIGN: Prospective case series. METHODS: The study comprised consecutive pediatric cataract cases planned for bag-in-the-lens intraocular lens (BIL IOL) implantation...
October 2018: Journal of Cataract and Refractive Surgery
Orhan Beger, Turan Koç, Burhan Beger, Gülden Kayan, Deniz Uzmansel, Zeliha Kurtoğlu Olgunus
PURPOSE: The main objective of the study was to examine the use of teres major (TM) as a flap in the pediatric surgeries from an anatomical perspective by: (1) revealing the growth dynamics of the developing TM; (2) assessing the possible interconnecting structures between TM and latissimus dorsi (LD); (3) exposing the innervation patterns of TM in human fetuses. METHODS: Study was conducted on 50 fetuses (26 females and 24 males), on a mean gestational age of 22...
August 22, 2018: Surgical and Radiologic Anatomy: SRA
Lisa W Howley, Debnath Chatterjee, Sonali S Patel, Bettina F Cuneo, Timothy M Crombleholme, Nicholas Behrendt, Michael V Zaretsky, Ahmed I Marwan, Jeannie Zuk, Henry L Galan, Cristina Wood
INTRODUCTION: The use of perioperative tocolytic agents in fetal surgery is imperative to prevent preterm labor. Indomethacin, a well-known tocolytic agent, can cause ductus arteriosus (DA) constriction. We sought to determine whether a relationship exists between preoperative indomethacin dosing and fetal DA constriction. MATERIALS AND METHODS: This is an IRB-approved, single-center retrospective observational case series of 42 pregnant mothers who underwent open fetal myelomeningocele repair...
August 29, 2018: Fetal Diagnosis and Therapy
Hidetake Kamei, Yu Wakimoto, Yumi Murakami, Maya Omote, Kayoko Harada, Atsushi Fukui, Hiroyuki Tanaka, Hideaki Sawai, Hiroaki Shibahara
Many patients, after artificial valve replacement surgery, receive warfarin anticoagulant therapy. However, it has been reported that warfarin administration during pregnancy can cause fetal teratogenicity. With reference to this case, we will discuss how warfarin administration in mid-pregnancy caused severe cerebral hemorrhage in the newborn child. The 36-year-old patient in this case underwent aortic valve replacement surgery when she was 11 years old; this requires the continued use of warfarin after surgery...
2018: Case Reports in Obstetrics and Gynecology
Muriel Coupaye, Hélène Legardeur, Ouidad Sami, Daniela Calabrese, Laurent Mandelbrot, Séverine Ledoux
BACKGROUND: There is a lack of evidence on whether sleeve gastrectomy (SG), which induces fewer nutritional deficiencies than Roux-en-Y gastric bypass (RYGB), also affects fetal growth (FG). OBJECTIVES: To compare neonatal outcomes after RYGB and SG and to assess the impact of maternal nutritional alterations on FG after both procedures. SETTING: University Hospital, France. METHODS: Women with singleton pregnancies who had at least 1 nutritional evaluation in our institution between 2004 and 2017 were included...
July 20, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Benjamin Elliot Yelnosky Smith, Deborah Bartz, Alisa B Goldberg, Elizabeth Janiak
Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term "elective" in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care. We analyzed interviews with 41 U...
July 10, 2018: Social Science & Medicine
Dana S Hutchinson, Nadine Brew, Teresa Vu, Jon Merlin, Nadia Hale, David William Walker, Flora Y Wong
Preterm infants frequently suffer cardiovascular compromise, with hypotension and/or low systemic blood flow, leading to tissue hypoxia-ischemia (HI). Many preterm infants respond inadequately to inotropic treatments using adrenergic agonists such as dobutamine or dopamine. This may be due to altered cardiac adrenoceptor expression due to tissue HI, or prolonged exposure to adrenergic agonists. We assessed the effects of severe HI with and without dobutamine/dopamine treatment on cardiac adrenoceptor expression in preterm fetal sheep...
August 23, 2018: Journal of Applied Physiology
Jae Yeon Lee, Hyeonji Kim, Dong-Heon Ha, Jong Chul Shin, Ahyoung Kim, Hyun Sun Ko, Dong-Woo Cho
Although recent invasive fetal surgeries have improved fetal outcomes, fetal membrane rupture remains a major complication, leading to premature delivery, thus undermining the complete benefits of such procedures. A biocompatible amnion-analogous medical device (AMED) consisting of polycaprolactone framework and decellularized amniotic membrane (dAM)-derived hydrogel for restoration of amniotic membrane defect is developed using 3D printing technology. Its efficacy on healing iatrogenic fetal membrane defects in vitro is evaluated, showing that the dAM gel contains migratory and proliferative properties...
September 2018: Advanced Healthcare Materials
Jan Deprest, Adalina Sacco
The management of fetal spina bifida used to be relatively straight-forward. An uncommon condition with a high termination rate in many other countries, the prenatal management for those continuing pregnancy involved planning for postnatal surgery and often delivery by elective caesarean section. In the last 10 years much has changed, due to the advent of fetal surgery and now Tolcher et al (BJOG 2018;xxx) question the delivery practice. This article is protected by copyright. All rights reserved.
August 21, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
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