Abstract:
OBJECTIVE:To determine the safety and efficacy of ventriculoamniotic shunt placement through a hysterotomy in the second trimester of pregnancy as treatment for isolated obstructive hydrocephalus. METHODS:Between 1999 and 2003, four pregnancies with isolated fetal obstructive hydrocephalus in the second trimester were treated at Vanderbilt University Medical Center. Preoperatively, all fetuses underwent serial ultrasonographic examinations and an ultrafast magnetic resonance imaging to confirm isolated aqueductal stenosis. A normal fetal karyotype and negative polymerase chain reaction or culture of the amniotic fluid for cytomegalovirus and toxoplasmosis were obtained. Serial enlargement of the lateral ventricles >1.5 mm/week and fetal macrocephaly were documented. Using epidural and GETA, a standard ultrasmall ventricular catheter and valve were inserted via a hysterotomy. The distal catheter, rather than being inserted into the fetal peritoneum, exited between the fetal scapulae. Patients were discharged home from the hospital, and the remainder of their prenatal care was provided by their local obstetrician. After delivery, the distal drain was converted to a ventriculoperitoneal shunt. RESULTS:Cases were performed at 23 6/7, 25 5/7, 26 4/7, and 26 5/7 weeks. Shunts performed well during pregnancy, and were intact at delivery. Deliveries occurred at 34 1/7, 27 1/7, 28, and 32 4/7 weeks. Birthweights were 2,010, 907, 1,200, and 2,220 g. All Apgar scores were normal. Case 1 developed a neonatal shunt infection, and is now developmentally delayed, with swallowing dysfunction, hearing deficits and a poor pupillary response. Case 2 developed neonatal sepsis and is now developmentally delayed. Case 3 delivered preterm due to chorioamnionitis, and neonatal death occurred from sepsis. Case 4 is developmentally delayed. CONCLUSIONS:Ventriculoamniotic shunt can be placed through a hysterotomy, overcoming many of the technical difficulties of earlier percutaneous shunts. However, recent developments in fetal imaging and molecular genetics have not improved case selection. Unless new breakthroughs occur, fetal shunting cannot reasonably be expected to improve perinatal outcome.
journal_name
Fetal Diagn Therjournal_title
Fetal diagnosis and therapyauthors
Bruner JP,Davis G,Tulipan Ndoi
10.1159/000095668subject
Has Abstractpub_date
2006-01-01 00:00:00pages
532-9issue
6eissn
1015-3837issn
1421-9964pii
95668journal_volume
21pub_type
杂志文章abstract::Electronic fetal monitoring (EFM) is a poor predictor of outcomes attributable to delivery problems. Contextualizing EFM by adding maternal, obstetrical, and fetal risk-related information to create an index called the Fetal Reserve Index (FRI) improves the predictive capacity and facilitates the timing of interventio...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000494617
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVES:Non-invasive prenatal diagnosis using circulating fetal trophoblast cells has been challenging due to lack of a reproducible trophoblast-specific antibody. We investigated the use of three trophoblast cell-specific antibodies, HLA-G, placenta growth factor, and neuroD2, for the isolation of trophoblast cells...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000097102
更新日期:2007-01-01 00:00:00
abstract::Fetuses with anti-SSA-mediated complete atrioventricular block (CAVB) are at high risk for perinatal death if they present at <20 weeks of gestation and develop ventricular rates of <55 beats per minute (bpm), cardiac dysfunction, or hydrops [Izmirly et al.: Circulation 2011;124:1927-1935; Jaeggi et al.: J Am Coll Car...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000475815
更新日期:2017-01-01 00:00:00
abstract::Of 44 pregnancies obtained at the Tenon Maternity Hospital by in vitro fertilization (IVF) using donated oocytes, 25 have already been completed by spontaneous delivery or cesarean section: 22 (88%) single; 2 (8%) twins, and 1 (4%) triple. The most frequently seen complications of pregnancy were hypertension (16%) and...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000263647
更新日期:1992-01-01 00:00:00
abstract::The objectives of the study were to assess the ability of a fetal pulse oximeter to measure the fetal oxygen saturation (SPO2) continuously during labor and to assess the correlation between readings of fetal pulse oximetry and cord blood gases at birth. The Nellcor N-400 Fetal Oximeter was used in 62 women prospectiv...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000264277
更新日期:1996-01-01 00:00:00
abstract::The process of monozygotic twinning in animals and humans is presented. In addition, congenital defects in monozygotic twins versus dizygotic twins and singletons is discussed. Overall, the rates of congenital anomalies are higher among whites as compared to blacks, males as compared to females, and multiples as compa...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
doi:10.1159/000263545
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:Evidence of meconium-stained amniotic fluid (AF) during labor suggests implementation of close monitoring of fetal well-being. We have investigated whether the presence of meconium in the AF on admission for labor is as important a predictor of neonatal outcome as a change in AF color during labor. METHODS:A...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000081359
更新日期:2005-01-01 00:00:00
abstract::In order to determine the frequency of associated malformations and chromosomal defects in patients with congenital diaphragmatic hernia (CDH) our experiences with CDH during the last 8 years (1985-1993) were reviewed. During the study period, 33 fetuses (prenatal group) with CDH were examined at our level III ultraso...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
doi:10.1159/000264193
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVE:To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for twin-twin transfusion syndrome. METHODS:A systematic review and meta-analysis of studies on cerebral injury and long-term impairment after amn...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,meta分析,评审
doi:10.1159/000341814
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of smoking and number of previous births on maternal serum levels of alpha-fetoprotein and free beta-subunit of human chorionic gonadotropin (free beta-hCG). METHODS:The study included 3,252 completed unaffected singleton pregnancies that proceeded beyond 37 weeks' gestation and result...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000047999
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS). METHODS:A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004-2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal com...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000336227
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:To evaluate pre-intervention echocardiographic parameters of cardiac function in fetuses who survive without hydrops as compared to fetuses who develop hydrops or perinatal death in the setting of sacrococcygeal teratoma (SCT) and twin-reversed arterial perfusion sequence (TRAP). METHODS:Clinical, echocardio...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000330762
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:The only causal therapy is fetoscopic laser surgery (FLS). The aims of this study were to analyze the long-term outcome of monochorionic twins treated by FLS, including their school career, need for therapy and special aid equipment, and free-time activities, and compare their outcome to matched dichorioni...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000509400
更新日期:2020-01-01 00:00:00
abstract:INTRODUCTION:Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for the treatment of twin-twin transfusion syndrome (TTTS). OBJECTIVE:The aim of this work was to determine whether a quantitative grading system of membrane separation following SLPCV ...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000504361
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To assess the relationship between the volume of amniotic fluid removed and the change in amniotic fluid index (AFI) and calculate an equation describing this association. MATERIALS AND METHODS:A retrospective analysis of 19 amnioreduction procedures performed in our unit. Multiple regression analysis was u...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000020939
更新日期:1999-09-01 00:00:00
abstract:INTRODUCTION:Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the ...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000512658
更新日期:2021-01-28 00:00:00
abstract::Congenital cardiac diverticula are transmural localized protrusions within the free wall of the ventricles. Right ventricular diverticula are rarely diagnosed during the fetal period, and due to their rarity, their natural history remains unclear. We present a case of prenatal diagnosis of right ventricular diverticul...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
doi:10.1159/000196815
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:To evaluate lower extremity neuromotor function (LENF) and short-term ambulatory potential following fetal myelomeningocele (fMMC) closure. METHODS:Retrospective chart review of 54 children that underwent fMMC closure at our institution prior to the NIHCD-MOMS trial. Neonatal LENF was compared to predicted f...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000197359
更新日期:2009-01-01 00:00:00
abstract::Prenatal diagnosis of oral cystic lesions is rare but is reported more frequently. The diagnosis of sublingual cyst is important because of the potential for airway obstruction. A rare case of a foregut duplication cyst associated with unilateral sclerocorneal microphthalmia is reported. The differential diagnosis and...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000235883
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:Myelomeningocele is a neural tube defect resulting in an exposed spinal cord, which leads to irreversible neurologic damage at birth. We proposed development of a fetal rabbit model of myelomeningocele to study in utero spinal cord injury and repair strategies. METHODS:New Zealand white rabbits (n = 10) at 2...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000021021
更新日期:2000-09-01 00:00:00
abstract::The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphr...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
doi:10.1159/000446942
更新日期:2016-01-01 00:00:00
abstract::Several isolated reports of fetal goiter treatment have shown limited generalizability of approaches and provide no real guidance for optimal timing, dosages, and treatment strategies. Graves' disease accounts for >60% of these cases. Maternal treatments of hyperthyroidism include antithyroid medications such as methi...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000437367
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVES:We evaluated the hypothesis that in fetuses with congenital heart disease (CHD) there is a correlation between the expected pattern of in utero brain blood supply and the severity of neurodevelopmental impairment. METHODS:A total of 58 fetuses with CHD and 58 controls underwent a Doppler ultrasound and feta...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000439527
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:To measure levels of total plasma cysteine, homocysteine, cysteinylglycine and glutathione of normotensive primiparous pregnant women in the second and the third trimester. METHODS:Two consecutive blood samples were taken from 65 healthy primiparous women in the 19th to 21st weeks of pregnancy and then in th...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000100785
更新日期:2007-01-01 00:00:00
abstract::In the last 6 years early amniocentesis for the prenatal diagnosis of chromosome aberrations has been established in many centers worldwide, but knowledge about the gynecological safety of the procedure is sparse. From 1990 to 1995 at the Evangelisches Krankenhaus Oberhausen (Germany) 3,277 early amniocenteses (betwee...
journal_title:Fetal diagnosis and therapy
pub_type: 临床试验,杂志文章
doi:10.1159/000264454
更新日期:1997-05-01 00:00:00
abstract::Reproductive genetic testing technologies are expanding at an exponential rate. Nurses are increasingly being called upon to provide these services to women. This paper discusses the status of nursing education in genetics and identifies immediate needs for nurses in order to be adequately prepared to respond to these...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000263892
更新日期:1993-04-01 00:00:00
abstract:INTRODUCTION:Chronic reduction of oxygen and nutrient delivery to the fetus has been related to neurodevelopmental problems. Placental underperfusion induces a significant reduction in oxygen and nutrient delivery, whereas maternal undernutrition causes mainly nutrient deficiency. A comparison of the neurodevelopmental...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000454859
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:To determine normal values for amniotic fluid index (AFI) in uncomplicated post-dates singleton pregnancies and compare it to current reference ranges. POPULATION:Four hundred and forty-eight women with singleton, uncomplicated pregnancies, presenting for post-dates assessment (gestation 40+0 to 42+0 weeks) ...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000265554
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The management of a case of severe twin-to-twin transfusion syndrome at 24 weeks of gestation is presented, using a combined surgical and medical approach. METHODS:Operative fetoscopy was used to coagulate placental vessels crossing the intertwin membranes. Repeated intrauterine transfusions were used to cor...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000020809
更新日期:1998-03-01 00:00:00
abstract::The authors performed a color Doppler ultrasound examination of both renal and interlobar arteries of 15 pregnant women affected by pregnancy-induced hypertension. The pulsatility index (PI), the resistance index (RI) and the systolic/diastolic ratio (S/D) values were compared with those of 15 healthy pregnant women o...
journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000264292
更新日期:1996-03-01 00:00:00