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At least 613 records · Page 34Linked to original sources
PubMed1991

The role of light and sound technologies in the detection of vasa praevia.

Velamentous vessels across the internal os are rare (1 in 5000) but the high perinatal mortality (50-70%) has not improved with traditional methods of detection. In late pregnancy, Low Intrauterine Transcervical Endoscopy (LITE) can aid detection. Using LITE, such vessels have been 'seen' in 3 of 5000 patients examined; one case was detected fortuitously in 2500 patients examined during 1965-70, and two were detected in a special subgroup from 2500 patients examined during 1971-89 in which LITE was performed prior to labour with the express aim of excluding vasa praevia. Detection occurred before labour and in the absence of antepartum haemorrhage. In all three cases, the cervix was not dilated beyond 1 cm and a single velamentous vessel was found. The absence of labour and haemorrhage probably contributed to a zero perinatal mortality. Recently, ultrasound has been used in the detection of vasa praevia. Combination of abdominal real-time ultrasonography with LITE has permitted comparison of the efficacy of these two techniques; two of the patients with vas praevium were ultrasound negative but LITE positive. The risk of vasa praevia should be considered (a) when ultrasonography has shown a bilobed or succenturiate placenta, a low-lying placenta where the cord has a battledore insertion, a migrating placenta, or a suspicion of velamentous vessel traversing the internal os, (b) when there is a multiple or IVF pregnancy, or (c) when there is intrapartum bleeding or an irregularity in fetal heart rate. Inexperienced practitioners using LITE risk the rupture of a vas praevium. However, efficiently performed for those patients at increased risk of fetal hypoxia, or to detect meconium pollution of the amniotic sac or prior to amniotomy, LITE may fortuitously reveal a vas praevium and thereby enable action that prevents iatrogenic or spontaneous rupture.

Amnion↗
PubMed2005

Magnetic resonance imaging of the feto-placentar unit after fetoscopic laser coagulation for twin-to-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies that results from a hemodynamical imbalance of placentar vascular anstomoses that connect the circulation of both fetuses. In TTTS, a poly/oligohydramnios sequence with high fetal morbidity and mortality rates occurs. Fetoscopic laser coagulation of the placentar anastomoses can limit or prevent fetal injury. The purpose of this report is to present and discuss fetal magnetic resonance imaging as a postoperative imaging tool after fetoscopic laser coagulation.

Adult↗
PubMed1982

The current scope of antenatal diagnosis.

Progress in medical technology has made possible the antenatal identification of fetuses at risk for chromosomal, biochemical, or multifactorial genetic defects. Amniocentesis and adjunctive procedures are beginning to be used as a basis for prenatal treatment. Experience has shown that more than 95% of couples at risk can be reassured that they will not produce a defective offspring.

Amniocentesis↗
PubMed1997

Amnioscopic endofetal illumination with infrared-guided fiber.

Minimally invasive amnioscopic surgery has several potential advantages over traditional open hysterotomy, including the reduction of the risk of preterm labor and spontaneous abortion. Adequate visibility of the fetal target organ is obligate to the success of in utero procedures. This is a preliminary report on the use of an end-emitting infrared fiber (750 microns; 810-nm wavelength) that allows image fusion with Infravision videocamera systems (Gabriel Medical, Lafayette, LA). Once placed, this fiber can serve as a homing beacon to identify the fetal bladder in the surgical creation of an amnioscopic vesicostomy for the relief of obstructive uropathies. Under general endotracheal halothane anesthesia, amnioscopic access was established in time-dated pregnant ewes using one 3.7-mm and two radially dilating 2-mm to 5-mm trocars. This access allowed the investigation of several methods of intravesicular infrared fiber placement. Ultrasound-guided direct needle puncture is the quickest method of accessing the fetal bladder but is unreliable when the bladder is empty. Accurate placement of the access needle directly over the suprapubic region was accomplished with amnioscopic assistance. The fiber was also placed transurethrally in one female and one male fetus, with subsequent perforation of the female's bladder. Successful infrared bladder illumination was accomplished in all animals. The fusion integration of this camera system allows simultaneous viewing by visible spectrum and near-infrared wavelengths. We believe that this system provides a further degree of safety for amnioscopic procedures.

Animals↗
PubMed1997

Assessment of access strategies for fetoscopic urologic surgery: preliminary results.

Attempted endoscopic fetal interventions have been increasingly reported, given the knowledge that minimizing the trauma to the uterus by a small access portal can allow prolonged amnioscopic-guided surgery. Numerous fetal anomalies have been targeted for these interventions, including congential obstructive uropathies. This preliminary investigation explored innovative access strategies utilizing time-dated pregnant ewes, 95 to 100 days' gestation (term 145 days). Two strategies were specifically investigated: percutaneous, ultrasonographically guided microamnisocopy and ultrasonographically aided, laparoscopically guided amnioscopy. Both strategies provided excellent fetal visibility and were facilitated by the use of small trocars and microlaparoscopic instrumentation, which promoted prolonged amnioscopy with minimal access trauma.

Amnion↗
PubMed2006

Clinically applicable procedure for gene delivery to fetal gut by ultrasound-guided gastric injection: toward prenatal prevention of early-onset intestinal diseases.

Targeting gene therapy vectors to the fetal intestinal tract could provide a novel means toward prevention of the early postnatal intestinal pathology of cystic fibrosis and other conditions, such as congenital enteropathy, that cause intestinal failure. Among these conditions, cystic fibrosis is by far the most common lethal genetic disease. It is caused by a functional absence or deficiency of the cystic fibrosis transmembrane conductance regulator and manifests in the gut as meconium ileus. Prenatal treatment of genetic disease may avoid early-onset tissue damage and immune sensitization, and may target cells that are less accessible in the adult. We investigated gene transfer to the fetal gut, using a minimally invasive injection technique. First-generation replication-deficient adenoviral vectors encoding the beta-galactosidase gene and transduction-enhancing agents were injected into the stomach of early-gestation fetal sheep (n = 8, 60 days of gestation; term, 145 days) under ultrasound guidance. Reporter gene expression was observed 2 days after injection in the villi of the gastrointestinal epithelia after 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside staining and beta-galactosidase immunohistochemistry of fetal tissues. Expression of beta-galactosidase, as measured by enzyme-linked immunosorbent assay, was enhanced after pretreatment of the fetal gut with sodium caprate, which opens tight junctions, and after adenovirus complexation with DEAE-dextran, which confers a positive charge to the virus. Instillation of the fluorocarbon perflubron after virus delivery resulted in tissue transduction from the fetal stomach to the colon. Using a clinically relevant technique, we have demonstrated widespread gene transfer to the fetal gastrointestinal epithelia.

Adenoviridae↗
PubMed2003

Embryoscopic and cytogenetic analysis of 233 missed abortions: factors involved in the pathogenesis of developmental defects of early failed pregnancies.

BACKGROUND: While chromosomal abnormalities are often the cause of missed abortions, other defects could be involved, which might be screened for by transcervical embryoscopy. METHODS: A total of 272 patients with missed abortion underwent transcervical embryoscopy prior to dilatation and curettage, together with cytogenetic analysis of chorionic villi, using either standard G-banding cytogenetic techniques or comparative genomic hybridization in combination with flow cytometry analysis. RESULTS: Visualization of the embryo or early fetus (12 cases) was successful in 233 patients, and karyotyping in 221. Among 233 examined cases, 33 had normal external features, 71 were classified as growth-disorganized and 129 had either isolated or multiple defects, including holoprosencephaly, anencephaly, encephalocele, spina bifida, microcephaly, facial dysplasia, limb reduction defect, cleft hand, syndactyly, pseudosyndactly, polydactyly, various forms of cleft lip and an amniotic adhesion. Of the 165 cases with an abnormal karyotype, there were 46 grossly disorganized embryos, 98 multiple defects, six single defects and 15 morphologically normal cases. Of the 56 cases with a normal karyotype, there were 20 grossly disorganized embryos, 16 multiple defects, four single defects and 16 morphologically normal cases. CONCLUSIONS: A total of 75% of the cases with missed abortion had an abnormal karyotype, 18% had a morphological defect with a normal karyotype, while no embryonic or chromosomal abnormality could be diagnosed in 7% of the cases. Correlation of morphological and cytogenetic findings in spontaneous abortion specimens could provide valuable information for genetic counselling and prenatal care in future pregnancies in couples with a history of repeated pregnancy loss.

Abnormalities, Multiple↗
PubMed2000

Anesthesia for fetoscopic fetal surgery: twin reverse arterial perfusion sequence and twin-twin transfusions syndrome.

IMPLICATIONS: Twin reversed arterial perfusion sequence and twin-twin transfusion syndrome can be managed by fetoscopic fetal surgery. It is important to consider the fetal, uteroplacental, and maternal issues when choosing an anesthetic technique. We report on three patients with differing anesthetic issues using fetoscopic surgery for umbilical cord coagulation.

Adult↗
PubMed2001

Fetal surgery for myelomeningocele.

Myelomeningocele is a devastating birth defect affecting a significant number of live births worldwide. Prenatal repair of myelomeningocele has been performed in the United States for 5 years with mixed results. The initial intent was to preserve distal neurological function by covering the exposed spinal cord. Although there has been relatively little effect on distal sensorimotor function, prenatal repair serendipitously led to an apparent reduction in hindbrain herniation and a possible decreased need for ventriculoperitoneal shunting. The long-term clinical consequences of these findings are not clear. What is clear, however, is that further study in the form of a prospective, randomized trial is mandatory.

Animals↗
PubMed2003

Monochorionic diamniotic twins: complications and management options.

PURPOSE OF REVIEW: Monochorionic compared with dichorionic twins have disproportionately high fetal loss rates, perinatal mortality and morbidity. This is because of the unpredictable vascular anastomoses and the often asymmetrical distribution of the single placenta between both twins. RECENT FINDINGS: The pathophysiology of twin-to-twin transfusion syndrome is usually explained on an angioarchitectural basis, although certain hemodynamic and hormonal factors also may be involved. The results of the large randomized trials on amnioreduction, fetoscopic laser coagulation and septostomy are still awaited. An update is given on hardware and instruments required for fetoscopic laser. Subsequently, the problem of the monochorionic twin set with severe early discordant growth is addressed. Several etiological mechanisms have been proposed, but little is known of its natural history. Also, umbilical artery Doppler waveforms may not have the same predictive value as in singletons. Prophylactic laser coagulation of the vascular anastomoses to protect against the adverse effects of single intrauterine demise, has so far not been shown to confer any benefit in outcome. Finally, pathophysiology and management of discordant structural and chromosomal anomalies in monochorionic twins are discussed. Laser and monopolar coagulation, which can be introduced through a needle, may be used for selective feticide in early pregnancy or low hemodynamic conditions. Bipolar coagulation seems more effective at later gestational ages and normal hemodynamic conditions. SUMMARY: Our insight into the complications associated with monochorionic twins has increased in recent years. It is hoped that this will lead to better surveillance and ultimately an improved outcome for these high-risk pregnancies.

Amnion↗