Intrauterine shunt for obstructive hydrocephalus--still not ready.

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 Ther

authors

Bruner JP,Davis G,Tulipan N

doi

10.1159/000095668

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

532-9

issue

6

eissn

1015-3837

issn

1421-9964

pii

95668

journal_volume

21

pub_type

杂志文章
  • Refining the Prediction and Prevention of Emergency Operative Deliveries with the Fetal Reserve Index.

    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

    authors: Britt DW,Evans MI,Schifrin BS,Eden RD

    更新日期:2019-01-01 00:00:00

  • Antibodies to trophoblast antigens HLA-G, placenta growth factor, and neuroD2 do not improve detection of circulating trophoblast cells in maternal blood.

    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

    authors: Tjoa ML,Delli-Bovi L,Johnson KL,Bianchi DW

    更新日期:2007-01-01 00:00:00

  • Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia.

    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

    authors: Cuneo BF,Mitchell MB,Marwan AI,Green M,von Alvensleben JC,Reynolds R,Crombleholme TM,Galan HL

    更新日期:2017-01-01 00:00:00

  • Obstetric evolution of pregnancies obtained from donated oocytes.

    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

    authors: Cornet D,Antoine JM,Casanova S,Uzan S,Mandelbaum J,Plachot M,Salat-Baroux J

    更新日期:1992-01-01 00:00:00

  • Fetal pulse oximetry during labor of 62 patients.

    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

    authors: Langer B,Boudier E,Haddad J,Pain L,Schlaeder G

    更新日期:1996-01-01 00:00:00

  • Monozygotic twinning as a congenital defect and congenital defects in monozygotic twins.

    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

    authors: Luke B,Keith LG

    更新日期:1990-01-01 00:00:00

  • Prognostic value of change in amniotic fluid color during labor.

    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

    authors: Locatelli A,Regalia AL,Patregnani C,Ratti M,Toso L,Ghidini A

    更新日期:2005-01-01 00:00:00

  • Associated malformations and chromosomal defects in congenital diaphragmatic hernia.

    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

    authors: Bollmann R,Kalache K,Mau H,Chaoui R,Tennstedt C

    更新日期:1995-01-01 00:00:00

  • Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome: a systematic review and meta-analysis.

    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

    authors: van Klink JM,Koopman HM,van Zwet EW,Oepkes D,Walther FJ,Lopriore E

    更新日期:2013-01-01 00:00:00

  • The influence of smoking and parity on serum markers for Down's syndrome screening.

    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

    authors: Tislarić D,Brajenović-Milić B,Ristić S,Latin V,Zuvić-Butorac M,Bacić J,Petek M,Kapović M

    更新日期:2002-01-01 00:00:00

  • Fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome: a single-center experience.

    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

    authors: Rustico MA,Lanna MM,Faiola S,Schena V,Dell'avanzo M,Mantegazza V,Parazzini C,Lista G,Scelsa B,Consonni D,Ferrazzi E

    更新日期:2012-01-01 00:00:00

  • Echocardiographic risk stratification of fetuses with sacrococcygeal teratoma and twin-reversed arterial perfusion.

    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

    authors: Byrne FA,Lee H,Kipps AK,Brook MM,Moon-Grady AJ

    更新日期:2011-01-01 00:00:00

  • Long-Term Outcome of Monochorionic Twins after Fetoscopic Laser Therapy Compared to Matched Dichorionic Twins.

    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

    authors: Rüegg L,Hüsler M,Krähenmann F,Zimmermann R,Natalucci G,Ochsenbein-Kölble N

    更新日期:2020-01-01 00:00:00

  • Membrane Separation and Perinatal Outcomes after Laser Treatment for Twin-Twin Transfusion Syndrome.

    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

    authors: De Zoysa MY,Chon AH,Korst LM,Llanes A,Chmait RH

    更新日期:2020-01-01 00:00:00

  • Amnioreduction: how much to drain?

    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

    authors: Abdel-Fattah SA,Carroll SG,Kyle PM,Soothill PW

    更新日期:1999-09-01 00:00:00

  • Quantification of Posterior Risk Related to Intrapartum FIGO 2015 Criteria for Cardiotocography in the Second Stage of Labor.

    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

    authors: Cavoretto PI,Seidenari A,Amodeo S,Della Gatta AN,Nale R,Ismail YS,Candiani M,Farina A

    更新日期:2021-01-28 00:00:00

  • Prenatal diagnosis of fetal cardiac right ventricular diverticulum disappearing at three months of age. A case report and literature review.

    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

    authors: Perlitz Y,Mukary M,Lorber A,Ben-Ami M

    更新日期:2009-01-01 00:00:00

  • Lower extremity neuromotor function and short-term ambulatory potential following in utero myelomeningocele surgery.

    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

    authors: Danzer E,Gerdes M,Bebbington MW,Sutton LN,Melchionni J,Adzick NS,Wilson RD,Johnson MP

    更新日期:2009-01-01 00:00:00

  • Prenatal diagnosis of oral cyst caused by foregut duplication.

    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

    authors: Aviram R,Yaffe D,Kidron D,Tepper R,Regev R

    更新日期:2009-01-01 00:00:00

  • Creation of myelomeningocele in the fetal rabbit.

    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

    authors: Housley HT,Graf JL,Lipshultz GS,Calvano CJ,Harrison MR,Farmer DL,Jennings RW

    更新日期:2000-09-01 00:00:00

  • The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation.

    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

    authors: Tynan D,Alphonse J,Henry A,Welsh AW

    更新日期:2016-01-01 00:00:00

  • Sequential Amniotic Fluid Thyroid Hormone Changes Correlate with Goiter Shrinkage following in utero Thyroxine Therapy.

    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

    authors: Munoz JL,Kessler AA,Felig P,Curtis J,Evans MI

    更新日期:2016-01-01 00:00:00

  • Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply.

    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

    authors: Masoller N,Sanz-Cortés M,Crispi F,Gómez O,Bennasar M,Egaña-Ugrinovic G,Bargalló N,Martínez JM,Gratacós E

    更新日期:2016-01-01 00:00:00

  • Plasma cysteine concentrations in uncomplicated pregnancies.

    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

    authors: Viskova H,Vesela K,Janosikova B,Krijt J,Visek JA,Calda P

    更新日期:2007-01-01 00:00:00

  • On the complication risk of early amniocentesis versus standard amniocentesis.

    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

    authors: Eiben B,Hammans W,Hansen S,Trawicki W,Osthelder B,Stelzer A,Jaspers KD,Goebel R

    更新日期:1997-05-01 00:00:00

  • Reproductive genetic testing: implications for nursing education.

    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

    authors: Thomson EJ

    更新日期:1993-04-01 00:00:00

  • Neurodevelopmental Effects of Undernutrition and Placental Underperfusion in Fetal Growth Restriction Rabbit Models.

    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

    authors: Illa M,Eixarch E,Muñoz-Moreno E,Batalle D,Leal-Campanario R,Gruart A,Delgado-García JM,Figueras F,Gratacós E

    更新日期:2017-01-01 00:00:00

  • Amniotic fluid index in low-risk, post-dates pregnancies.

    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

    authors: Griffin M,Attilakos G,Greenwood R,Denbow M

    更新日期:2009-01-01 00:00:00

  • Management of a case of twin-to-twin transfusion syndrome by a combined surgical approach.

    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

    authors: Van Peborgh P,Pelletier G,Suarez B,Ville Y

    更新日期:1998-03-01 00:00:00

  • Maternal renal and interlobar arteries waveforms evaluation with color Doppler ultrasound in pregnancy-induced hypertension.

    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

    authors: Boemi G,Bruno MT,La Ferrera G,Butera L,Pulvirenti G,Lanzone A,Mancuso S

    更新日期:1996-03-01 00:00:00