2. Fetal Therapy: Options and Medical
Treatment
Pacemakers In the past two decades,
the goal of prenatal diagnosis has
changed from merely deciding about
terminating the pregnancy to possible
active intervention for improving the
long-term outcome of the fetus.
Recently, medical and surgical fetal
therapy has emerged as an option for
the management of various fetal
malformations.
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10. Survival rate in Rh Isoimmunized Fetuses
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11. Survival for In-Vitro Transfused
Hydroponic Fetuses
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12. Pathophysiology of Transfusion
To calculate the
volume of donor
blood necessary to
achieve a post-
tranfusion fetal
hematocrit of 40%,
the estimated
fwtoplacental blood
volume (left, e.g.,
100mL at 27 weeks)
is multiplied by DF
(right, e.g., 0,8 for a
pretransfusion fetal
hematocrit of 10%
and a donor
hematocrit of 80%).
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14. Fetal Obstructive Hydrocephalus: Distribution by
Primary Diagnosis and Survival in 41 Treated Cases
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22. Prognostic Criteria for The Fetus with Bilateral
Obstructive Uropathy
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23. Management
scheme for the
fetus with bilateral
hydronephrosis.
Note that the
development of
prognostic criteria
based on the
assessment of fetal
renal function
allows improved
counseling and
management.
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25. Surgical Interventions
Three approaches are currently used for
invasive
A.Ultrasonography-guided vesicoamniotic
and, less commonly, thoracoamniotic shunt
placement, is used in a fetus from 16 weeks'
gestation to when lung maturity makes
postnatal treatment the best option.
Complications are inadequate function,
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migration, and iatrogenic gastroschisis.
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26. B. Fetoscopic techniques now have a
clinical application in the ligation of
umbilical cords in acardiac twins, in
selective laser photocoagulation of
communicating vessels in twin-to-
twin transfusions, and in the
ablation of posterior urethral valves.
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27. 1. The procedure is performed
inside the uterus using
endoscopes, with a much
smaller hysterotomy than that
needed for open procedures.
This lessens the risks of
preterm labor and fetal
hypothermia and improves fetal
hemostasis during the
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28. 2. The success of the procedure depends
on the use of both a transabdominal
ultrasonographic intraoperative view
and a simultaneous endoscopic view
to guide placement of the trocars and
cannulae.
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29. 3. The drawbacks of fetoscopic surgery
are the risk of bleeding (avoiding the
transplacental route decreases this
risk), rupture of membranes, and
chorioamnionitis. Fetoscopy may also
be difficult because of poor access to
the fetus due to fetal position or
polyhydramnios.
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30. C. Open fetal surgery is currently
performed at select centers in
instances in which the risk of the
procedure to the mother and fetus is
overridden by a diagnosis with a
known poor outcome. Complications
such as chorioamnionitis, preterm
labor, bleeding, and direct trauma to
the fetus are risks in most of these
procedures.
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31. Monitoring During Surgery
The parameters monitored during and after surgery
include the following:
•Myometrial contractions and intrauterine pressures.
• Maternal blood pressure, ECG, and pulse oximetric and
blood gas levels.
• Fetal pulse oximetric measurement (50%-60%
saturation), heart rate, blood gases, and ECG
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32. Monitoring During Surgery
• Ultrasonographic findings in
cases of fetoscopic surgery
• Fetal temperature (Maintain
temperature with continuous
warm sodium chloride irrigation,
minimized exposure, and
increased ambient temperature.)
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33. These surgical techniques are considered
appropriate for 9 lesions.
1. Obstructive uropathy
2. Hydrocephalus
3. Pleural effusion
4. Twin-To-Twin Transfusion syndrome
5. Amniotic band syndrome
6. Congenital Diaphragmatic Hernia
7. Congenital high airway obstruction syndrome
8. Sacrococcygeal teratoma.
9. Congenital Cystic Adenomatoid Maformartions
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