Fetal diagnosis and therapy
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Fetal. Diagn. Ther. · Jan 2018
ReviewEffect of Anesthesia on the Developing Brain: Infant and Fetus.
The potential for commonly used anesthetics and sedatives to cause neuroapoptosis and other neurodegenerative changes in the developing mammalian brain has become evident in animal studies over the past 15 years. This concern has led to a number of retrospective studies in human infants and young children, and some of these studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. This association is particularly evident for prolonged or repeated exposures. ⋯ This review will first briefly summarize the rapid brain growth and development in the fetus and neonate. Next, animal model data of anesthetic neurotoxicity in the fetus and neonate will be presented, followed by a review of recent human clinical anesthetic neurotoxicity trials. Finally, the rationale for studying dexmedetomidine as a potential neuroprotectant agent in anesthetic neurotoxicity will be reviewed along with study design for two human clinical trials involving dexmedetomidine.
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Fetal. Diagn. Ther. · Jan 2018
Review Meta Analysis Comparative StudyFetal Surgery for Myelomeningocele: A Systematic Review and Meta-Analysis of Outcomes in Fetoscopic versus Open Repair.
The Management of Myelomeningocele (MMC) Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes but was associated with high rates of obstetrical complications. This study compares outcomes of open and fetoscopic MMC repair. ⋯ Fetoscopic repair is a promising alternative to open fetal MMC repair with a lower risk of uterine dehiscence; however, fetoscopic techniques should be optimized to overcome the high rate of dehiscence and leakage at the MMC repair site. A fetoscopic approach via maternal laparotomy reduces the risk of preterm birth.
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Fetal. Diagn. Ther. · Jan 2018
Evaluation of Magnetic Resonance Imaging Safety and Imaging Issues Associated with the Occlusion Balloon Used during Fetoscopic Endoluminal Tracheal Occlusion.
Congenital diaphragmatic hernias can be successfully treated by fetoscopic tracheal occlusion (FETO), a minimally invasive procedure that may improve postnatal survival. The endoluminal balloon utilized for FETO contains a metallic component that may pose possible risks for the fetus and mother related to the use of magnetic resonance imaging (MRI). The objective of this study is to evaluate MRI-related imaging and safety issues (magnetic field interactions, heating, and artifacts) for the occlusion balloon used in FETO. ⋯ In this paper, we demonstrate that the risks of performing MRI at 3 T or less in a patient who has this occlusion balloon in place are acceptable (or MR conditional, using current terminology).
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Fetal. Diagn. Ther. · Jan 2017
Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience.
To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO). ⋯ In this study, FETO was associated with an infant survival of 47% in cases with isolated unilateral severe CDH. The post-FETO increase in O/E LHR was higher in fetuses that survived compared to those who died.
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Fetal. Diagn. Ther. · Jan 2017
Comparative StudyNon-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance.
Due to the importance of cardiovascular dysfunction and advances in the development and use of non-invasive cardiac output (CO) monitoring devices, there is a growing interest in their use in the obstetric population. The aim of this study was to compare two commercially available, non-invasive CO monitors in the assessment of heart rate (HR), stroke volume (SV), CO, cardiac index (CI) and total peripheral resistance (TPR) in an obstetric population. ⋯ Our findings suggest that the two methodologies perform similarly in both uncomplicated pregnancies and in pregnancies complicated by hypertensive disorders. The study findings do not preclude the use of USCOM® and NICOM® devices in pregnancy, but indicate that these platforms cannot be used interchangeably. Our findings demonstrate an improvement in MPD as gestation advances and, therefore, questions the validity of previous longitudinal studies investigating maternal haemodynamics using these methodologies. Our work also highlights the need to construct reference ranges for each device and for validation of each methodology against a reference method before their use in research or clinical practice.