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Complicações maternas decorrentes das cirurgias endoscópicas em Medicina fetal; Maternal complications following endoscopic surgeries in fetal Medicine

PERALTA, Cleisson Fábio Andrioli; SBRAGIA, Lourenço; CORRÊA-SILVA, Eloisa Pedroso de Barros; YOUNG OH, Gabriela Hae; BRAGA, Angélica de Fátima Assunção; GOMES, Débora Alessandra de Castro; BARINI, Ricardo
Fonte: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Publicador: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
36.25%
OBJETIVO: descrever as complicações maternas decorrentes dos procedimentos endoscópicos terapêuticos em Medicina fetal, realizados em um centro universitário no Brasil. MÉTODOS: estudo observacional retrospectivo que incluiu gestantes atendidas no período de Abril de 2007 a Maio de 2010. Esses casos foram submetidos aos seguintes procedimentos: ablação vascular placentária com laser (AVPL) por síndrome de transfusão feto-fetal (STFF) grave; oclusão traqueal fetal (OTF) e retirada de balão traqueal por via endoscópica por hérnia diafragmática congênita (HDC) grave e AVPL, com ou sem cauterização bipolar do cordão umbilical, por síndrome da perfusão arterial reversa (SPAR) em gêmeo acárdico. As principais variáveis descritas para cada condição clínica/tipo de cirurgia foram as complicações maternas e a sobrevida (alta do berçário) do neonato/lactente. RESULTADOS: cinquenta e seis gestantes foram submetidas a 70 procedimentos: STFF grave (34 pacientes; 34 cirurgias); HDC grave (16 pacientes; 30 cirurgias) e SPAR (6 pacientes; 6 cirurgias). Entre as 34 gestantes tratadas com AVPL por STFF, duas (2/34=5,9%) apresentaram perda de líquido amniótico para a cavidade peritoneal e sete (7/34=20,6%) tiveram abortamento após os procedimentos. A sobrevida de pelo menos um gêmeo foi de 64...

Evolução e prognóstico materno-fetal da cirurgia cardíaca durante a gravidez; Maternal-fetal outcome and prognosis of cardiac surgery during pregnancy; Evolución y pronóstico materno-fetal de la cirugía cardiaca durante el embarazo

ÁVILA, Walkiria Samuel; GOUVEIA, Ana Maria Milani; POMERANTZEFF, Pablo; BORTOLOTTO, Maria Rita Lemos; GRINBERG, Max; STOLF, Noedir; ZUGAIB, Marcelo
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
36.45%
FUNDAMENTO: A cirurgia cardíaca favorece o prognóstico materno em casos refratários à terapêutica clínica, contudo associa-se a riscos ao concepto quando realizada durante a gravidez. OBJETIVO: Analisar a evolução e o prognóstico materno-fetal de gestantes submetidas à cirurgia cardíaca no ciclo gravídico-puerperal. MÉTODOS: Estudou-se a evolução de 41 gestações de mulheres que tiveram indicação de cirurgia cardíaca no ciclo gravídico puerperal. A cardiotocografia fetal foi mantida durante o procedimento nas pacientes com idade gestacional acima de 20 semanas. RESULTADOS: A média da idade materna foi de 27,8 ± 7,6 anos, houve predomínio da valvopatia reumática (87,8%), e 15 dessas (41,6%) foram submetidas à reoperação, devido à disfunção de prótese valvar. A média do tempo de circulação extracorpórea foi de 87,4 ± 43,6 min, e a hipotermia foi utilizada em 27 casos (67,5%). Treze mães (31,7%) não apresentaram intercorrências e tiveram seus recém-nascidos vivos e saudáveis. A evolução pós-operatória das demais 28 gestações (68,3%) mostrou: 17 complicações maternas (41,5%); três óbitos (7,3%); 12 perdas fetais (29,2%) e quatro casos de malformação neurológica (10%), dois dos quais evoluíram para óbito tardio. Houve uma perda de seguimento após a cirurgia. Nove pacientes (21...

Fetal cystoscopy for severe lower urinary tract obstruction-initial experience of a single center

RUANO, Rodrigo; DUARTE, Sergio; BUNDUKI, Victor; GIRON, Amilcar Martins; Srougi, Miguel; ZUGAIB, Marcelo
Fonte: JOHN WILEY & SONS LTD Publicador: JOHN WILEY & SONS LTD
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.13%
Objective To report the experience with fetal cystoscopy and laser fulguration of posterior urethral values (PUV) for severe lower urinary tract obstruction (LUTO). Methods Between July 2006 and December 2008, fetal cystoscopy was offered to 23 patients whose fetuses presented with severe LUTO. favorable urinary analysis and gestational age <26 weeks. Fetal urinary biochemistry was evaluated before and after cystoscopy. All infants were followed 6-12 months after birth. Abnormal renal function was defined when serum creatinine higher than 50 mu mol/L (2 Standard Deviation) or the necessity of dialysis or renal transplantation. Autopsy was always performed whenever fetal or neonatal deaths occurred. Results Eleven patients decided to undergo fetal therapy and 12 elected to continue with expectant observation. There was no difference between both groups in gestation age at diagnosis and referral examinations. Urethral atresia was diagnosed in 4/11 (36.4%) fetuses by fetal cystoscopy. At 26 weeks, fetuses that were managed expectantly presented with worse urinary biochemistry results (p < 0.05). Survival rates and percentage of infants with normal renal function were significantly higher in the cystoscopic group than in the expectant group (P < 0.05). Conclusions Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the PUV under cystoscopy may prevent renal function deterioration improving postnatal outcome. Copyright (C) 2009 John Wiley & Sons...

Percutaneous Laser Ablation of Sacrococcygeal Teratoma in a Hydropic Fetus with Severe Heart Failure - Too Late for a Surgical Procedure?

RUANO, Rodrigo; DUARTE, Sergio; ZUGAIB, Marcelo
Fonte: KARGER Publicador: KARGER
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.29%
Sacrococcygeal teratoma (SCT) is the commonest solid fetal tumor. Perinatal prognosis is usually favorable, but sometimes it can be complicated by fetal hydrops being responsible for high risk of mortality. Fetal therapy in such cases has so far not been established. We report a case with a giant solid SCT associated with fetal hydrops and severe heart failure. 2D- and 3D-Doppler ultrasonography revealed great vessels originated from the medial sacral artery. Percutaneous laser ablation of these vessels was performed at 24 weeks of gestation. During the procedure, severe anemia was also diagnosed (hemoglobin 4.3 g/dl). Two days later, the fetus died and pathological examination revealed local tumor necrosis and blood hemorrhage inside the mass. We suggest that in such cases, fetal surgery may not be enough, being too late, and perhaps fetal clinical therapy for anemia and heart failure could be the best option at a gestational age of less than 28 weeks. Copyright (C) 2009 S. Karger AG, Basel

Early fetal cystoscopy for first-trimester severe megacystis

RUANO, R.; YOSHISAKI, C. T.; SALUSTIANO, E. M. A.; GIRON, A. M.; Srougi, Miguel; ZUGAIB, M.
Fonte: WILEY-BLACKWELL Publicador: WILEY-BLACKWELL
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.14%
Objectives To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis. Methods Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first-trimester megacystis. All infants were followed up for 6-12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred. Results Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19-20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis-microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with `isolated` posterior urethral valves. Conclusions Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons...

A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia

Ruano, Rodrigo; Yoshizaki, Carlos Tadashi; Silva, M. M. da; Ceccon, M. E. J.; Grasi, M. S.; Tannuri, Uenis; Zugaib, Marcelo
Fonte: WILEY-BLACKWELL; MALDEN Publicador: WILEY-BLACKWELL; MALDEN
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.07%
Objective Severe pulmonary hypoplasia and pulmonary arterial hypertension are associated with reduced survival in congenital diaphragmatic hernia (CDH). We aimed to determine whether fetal endoscopic tracheal occlusion (FETO) improves survival in cases of severe isolated CDH. Methods Between May 2008 and July 2010, patients whose fetuses had severe isolated CDH (lung-to-head ratio < 1.0, liver herniation into the thoracic cavity and no other detectable anomalies) were assigned randomly to FETO or to no fetal intervention (controls). FETO was performed under maternal epidural anesthesia supplemented with fetal intramuscular anesthesia. Tracheal balloon placement was achieved with ultrasound guidance and fetoscopy between 26 and 30 weeks of gestation. All cases that underwent FETO were delivered by the EXIT procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was survival to 6 months of age. Other maternal and neonatal outcomes were also evaluated. Results Twenty patients were enrolled randomly to FETO and 21 patients to standard postnatal management. The mean gestational age at randomization was similar in both groups (P = 0.83). Delivery occurred at 35.6 +/- 2.4 weeks in the FETO group and at 37.4 +/- 1.9 weeks in the controls (P < 0.01). In the intention-to-treat analysis...

Investigação dos efeitos do emprego de celulose biossintética e matriz dérmica humana acelular na correção da meningomielocele intra-útero: estudo comparativo em fetos de ovelhas; Comparative study of byosinthetic cellulose (BC) and human acellular dermal matrix (HADM) in the in utero repair of myelomeningocele in fetal sheep model

Oliveira, Rita de Cassia Sanchez e
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 11/09/2007 PT
Relevância na Pesquisa
36.37%
Objetivo: Estudar os efeitos do emprego de dois materiais consideravelmente diferentes quanto à origem e custo na correção intra-uterina da meningomielocele criada experimentalmente em feto de ovino. Métodos: Em 36 fetos de ovinos foi criado um defeito aberto de tubo neural, com 75 de dias de gestação. Os casos foram divididos em três grupos: o controle onde o defeito não foi corrigido, grupo corrigido A onde o material utilizado para cobrir a medula exposta foi a matriz dérmica humana acelular (MDHA) e o grupo corrigido B onde o material foi a celulose biossintética (CB). Após a correção realizada com 100 dias, os fetos eram mantidos intra-útero até o termo da gestação. Os sacrifícios foram realizados com 140 dias e a coluna fetal era submetida à análise macro e microscópica onde foi observada a aderência dos materiais à pele, medula ou tecido nervoso remanescente. Resultados: Na fase inicial (piloto), 11 fetos foram operados e 4 sobreviveram (37%). Na segunda fase (estudo) 25 fetos foram operados e 17 sobreviveram (68%). No grupo de estudo, 6 fetos não foram submetidos à correção (grupo controle), 11 casos foram corrigidos e ocorreu 1 perda fetal. Do total de 10 casos, 4 constituíram o grupo A e 6, o grupo B. À macroscopia observou-se deslizamento da pele e tecidos subjacentes sobre a CB em todos os casos onde ela foi empregada e isto não ocorreu em nenhum dos casos onde a MDHA foi utilizada. Para comparar a aderência...

Avaliação da evolução neurocirurgica de crianças com diagnostico intrauterino de mielomeningocele e elaboração de protocolo de cirurgia fetal para prevenção de hidrocefalia; Assessment of neurosurgical outcomes in children prenatally diagnosed with myelomeningocele and developmento of a protocol for fetal surgery to prevent hydrocephalus

Helder Jose Lessa Zambelli
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/07/2006 PT
Relevância na Pesquisa
46.33%
O diagnóstico pré-natal da mielomeningocele permite melhor planejamento de sua abordagem e, mais recentemente, um possível reparo intra-útero. Este estudo analisa a evolução neurocirúrgica de 98 crianças com mielomeningocele, tratadas no período pós-natal através de cirurgia tradicional, de janeiro de 1994 a dezembro de 2002, no centro de referência em medicina fetal da Universidade Estadual de Campinas (UNICAMP). Desta avaliação retrospectiva, foi elaborado um protocolo próprio para cirurgia fetal para prevenção de hidrocefalia, identificando-se os fetos que se beneficiariam com a correção intra-útero da mielomeningocele. O estudo revelou uma realidade caracterizada pelo prognóstico ruim e pelo alto índice de complicações decorrentes da mielomeningocele, principalmente no que se diz respeito à hidrocefalia. Com isso, no protocolo foram incluídos somente fetos com um tamanho ventricular menor que 14 mm no momento da cirurgia, fetos entre 20 e 25 semanas de gestação, fetos com defeitos situados abaixo de L3-L4, fetos com mielomeningocele como malformação isolada e ausência de anomalias cromossômicas, tendo como critérios de exclusão: a primiparidade, fetos com lesão abaixo de S1 e a incapacidade de entendimento das gestantes dos riscos materno-fetais. Apesar da correção intra-útero para prevenção de hidrocefalia ter uma aplicação bastante restrita em nosso meio...

Defeitos de parede abdominal fetal : resultados do Programa de Medicina Fetal do CAISM-UNICAMP em dez anos; Fetal abdominal wall defects : 10-year data from the Fetal Medicine Program at CAISM-UNICAMP

Luciana Briganti
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 31/08/2007 PT
Relevância na Pesquisa
36.27%
Introdução: As malformações de parede abdominal fetal ocorrem entre a quinta e a décima semanas de idade gestacional, devido a falhas na seqüência normal do desenvolvimento embrionário. Costumam ser diagnosticadas precocemente com o uso da ultra-sonografia, geralmente por volta de doze semanas de gestação. A gastrosquise e a onfalocele são os defeitos mais comuns da parede abdominal. A gastrosquise, em geral, ocorre isoladamente, enquanto a onfalocele apresenta maior incidência com o aumento da idade materna, e comumente associa-se a anomalias genéticas. A adequada assistência em casos de malformação de parede abdominal demanda experiência do serviço e conhecimento da história natural da lesão. Objetivo: Avaliar a freqüência dos defeitos da parede abdominal fetal em gestantes atendidas no Ambulatório de Medicina Fetal do CAISMUnicamp entre 1996 e 2006, além de dados epidemiológicos e resultados neonatais. Sujeitos e Métodos: Foi realizado um estudo descritivo retrospectivo, através da revisão de prontuários de gestantes com fetos acometidos por malformações da parede abdominal. Os dados foram analisados através de tabelas de freqüência. Resultados: A freqüência das malformações de parede abdominal fetal nas gestantes estudadas foi de 33...

Fetal surgery.

Harrison, M R
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1993 EN
Relevância na Pesquisa
46.14%
While most prenatally diagnosed malformations are best managed by appropriate medical and surgical therapy after birth, a few may require or benefit from correction before birth. Extensive experimental work in animals and innovative technologic developments have made fetal surgery a viable approach to perinatal care. Managing preterm labor continues to be a vexing problem. At present, only a few life-threatening malformations have been successfully corrected. Additional research into the abnormal function of some malformations, the development of less interventional techniques, and fetal stem cell transplantation should lead to successful treatment of more fetal disorders.

Fetal surgery for neural tube defects

Sutton, Leslie N.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.2%
Open spina bifida remains a major source of disability despite an overall decrease in incidence. It is frequently diagnosed prenatally and can thus -- potentially -- be treated by fetal surgery. Animal studies and preliminary human studies strongly suggest that at least a portion of the neurological abnormalities seen in these patients are secondary, and occur in mid-gestation. It is estimated that approximately 400 fetal operations have now been performed for myelomeningocele world wide. Despite this large experience, the technique remains of unproven benefit. Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation (the Chiari II malformation), a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications. A randomized prospective trial (the MOMS trial) is currently being conducted by three centers in the United States, and is estimated to be completed in 2009.

Fetal Surgery

Laberge, Jean-Martin
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1986 EN
Relevância na Pesquisa
46.36%
Fetal surgery has come of age. For decades experimental fetal surgery proved essential in studying normal fetal physiology and development, and pathophysiology of congenital defects. Clinical fetal surgery started in the 1960s with intrauterine transfusions. In the 1970s, the advent of ultrasonography revolutionized fetal diagnosis and created a therapeutic vacuum. Fetal treatment, medical and surgical, is slowly trying to fill the gap. Most defects detected are best treated after birth, some requiring a modification in the time, mode and place of delivery for optimal obstetrical and neonatal care. Surgical intervention in utero should be considered for malformations that cause progressive damage to the fetus, leading to death or severe morbidity; that can be corrected or palliated in utero with a reasonable expectation of normal postnatal development; that cannot wait to be corrected after birth, even considering pre-term delivery; that are not accompanied by chromosomal or other major anomalies. At present, congenital hydronephrosis is the most common indication for fetal surgery, followed by obstructive hydrocephalus. Congenital diaphragmatic hernia also fulfills the criteria, but its correction poses more problems, and no clinical attempts have been reported so far. In the future many other malformations or diseases may become best treated in utero. The ethical and moral issues are complex and need to be discussed as clinical and experimental progress is made.

Surgery in the human fetus: the future

Flake, Alan W
Fonte: Blackwell Science Inc Publicador: Blackwell Science Inc
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
36.42%
Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. This led to experimental validation of the pathophysiology of specific fetal defects in animal models and to the development of techniques for their prenatal surgical correction. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s. Since that time, fetal surgery has been applied in only a few centres and has remained relatively limited in scope. Nevertheless, there has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. The purpose of this article is to briefly summarize the present status of fetal surgery and to speculate about what may be in store for the future. Inherent in such an effort is a definition of what constitutes fetal surgery. In this discussion I will take considerable latitude with the definition of what constitutes fetal surgery in the future...

Ethical challenges in fetal surgery

Smajdor, Anna
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.34%
Fetal surgery has been practised for some decades now. However, it remains a highly complex area, both medically and ethically. This paper shows how the routine use of ultrasound has been a catalyst for fetal surgery, in creating new needs and new incentives for intervention. Some of the needs met by fetal surgery are those of parents and clinicians who experience stress while waiting for the birth of a fetus with known anomalies. The paper suggests that the role of technology and visualisation techniques in creating and meeting such new needs is ethically problematic. It then addresses the idea that fetal surgery should be restricted to interventions that are life-saving for the fetus, arguing that this restriction is unduly paternalistic. Fetal surgery poses challenges for an autonomy-based system of ethics. However, it is risky to circumvent these challenges by restricting the choices open to pregnant women, even when these choices appear excessively altruistic.

Successful Outcome of a Triplet Gestation in a Patient with a History of an Open Maternal-Fetal Surgery

Rivers, Kathleen A.; Whitecar, Paul W.; Berry-Cabán, Cristóbal S.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.01%
Reproductive outcomes in women after pregnancy complicated by an open maternal-fetal surgery (OMFS) are limited. A review of the medical literature reveals only isolated cases of successful multiple pregnancies, and there are no prior documented cases of successful triplet gestations following OMFS. We report the delivery of a triplet gestation at 34-week gestation in a patient with a history of previous OMFS.

Increased maternal microchimerism after open fetal surgery

Saadai, Payam; MacKenzie, Tippi C.
Fonte: Landes Bioscience Publicador: Landes Bioscience
Tipo: Artigo de Revista Científica
Publicado em 01/07/2012 EN
Relevância na Pesquisa
46.38%
Maternal-fetal cellular trafficking (MFCT) during pregnancy leads to the presence of maternal cells in the fetus and of fetal cells in the mother. Since this process may be altered in cases of pregnancy complications, we asked whether open fetal surgery leads to changes in microchimerism levels. We analyzed maternal and fetal microchimerism in fetuses who underwent open fetal surgery for repair of spina bifida and compared their levels to patients who had postnatal repair and to healthy controls. We found that maternal microchimerism levels were increased in patients who had open fetal surgery compared with controls. In contrast, patients who had fetal intervention at the time of delivery did not demonstrate increased microchimerism. These results suggest that open fetal surgery may alter trafficking. Given the importance of MFCT in maternal-fetal tolerance, we discuss potential implications for the field of preterm labor and transplantation tolerance.

Update in fetal anesthesia for the ex utero intrapartum treatment (EXIT) procedure

Ngamprasertwong, Pornswan; Vinks, Alexander A; Boat, Anne
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
36.29%
The ex-utero intrapartum treatment (EXIT) is one type of fetal surgery, performed before delivery while the fetus remains attached to the uteroplacental circulation. This intervention improves neonatal morbidity and mortality of certain congenital diseases. For instance, securing the airway of a fetus with congenital airway obstruction while on uteroplacental circulation prevents the hypoxemia during the establishment of an airway post-delivery. Anesthesia for fetal surgery now incorporates new knowledge of the maternal/fetal response to anesthetic agents. This chapter reviews for the EXIT procedure the effects of maternal anesthesia on fetal hemodynamics, intravenous anesthesia to supplement inhalational anesthesia in order to provide maternal-fetal hemodynamic stability during surgery, intraoperative fetal monitoring, maternal pharmacokinetics approach to study placental drug transfer and fetal pharmacokinetics to improve our understanding of the effects of maternal anesthesia on the fetus.

FETAL NEUROSURGERY: UPDATES AND PERSPECTIVES; NEUROCIRURGIA FETAL-ATUALIDADES E PERSPECTIVAS

Zanon, Nelci; Collange Grecco, Luanda André; Resende Caselato, Giselle Coelho; Pedreira, Denise
Fonte: Revista Brasileira de Neurologia e Psiquiatria Publicador: Revista Brasileira de Neurologia e Psiquiatria
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 15/10/2014 POR
Relevância na Pesquisa
56.29%
Revision is aimed to describe the effects obtained with fetal neurosurgery, especially in cases of myelomeningocele, promoting a critical analysis of current affairs and prospects available in the literature. Relevant studies were consulted and included in this review. It is observed that the myelomeningocele is the main disease with neurosurgical statement with evidence to support the indication of fetal surgery. The main benefits are related to reduced association of Arnold-Chiari type II and hydrocephalus, improved motor development and positive change in the level of injury. Risks and adverse effects are described and involve the fetus and the mother. Currently fetal surgery procedures can be performed with the open and endoscopically. The most recent evidence points to a trend in the study of minimally invasive fetal techniques that provide greater protection for mother and baby.; Esta revisão teve como objetivo descrever os efeitos obtidos com as neurocirurgias fetais, principalmente em casos de mielomeningocele, promovendo uma análise critica das atualidades e perspectivas disponíveis na literatura. Importantes estudos foram consultados e incluídos nesta revisão. Observa-se que a mielomeningocele é a principal doença com indicação neurocirúrgica com evidências que suportem a indicação de cirurgias fetais. Os principais benefícios são relacionados com redução da associação da malformação de Arnold-Chiari tipo II e hidrocefalia...

Tratamento das malformações fetais intraútero; Intrauterine fetal abnormalities therapy

SBRAGIA, Lourenço
Fonte: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Publicador: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
46.37%
RESUMO Aproximadamente 1% das gestações apresenta anomalias estruturais. Durante as últimas três décadas, vários estudos experimentais em animais de grande porte associados ao avanço tecnológico dos equipamentos de imagem diagnóstica e de fetoscopia permitiram grande evolução no conhecimento da fisiopatologia de vários defeitos congênitos. Tais conhecimentos aplicados na correção intraútero das anomalias transformaram a história natural de muitas doenças que passaram do óbito para um considerável número de sobreviventes. Intervenção fetal, como a cirurgia fetal aberta, pode ser indicada na meningomielocele ou na malformação adenomatoide cística congênita e no teratoma sacrococcígeo, que levam à hidropsia fetal secundária. Além disso, procedimentos minimamente invasivos utilizando fetoscópios podem ter aplicação na hérnia diafragmática congênita, nas transfusões feto-fetais, na gravidez gemelar com feto acárdico, na válvula de uretra posterior e na hipoplasia de câmaras cardíacas com bons resultados. Embora cirurgia fetal aberta e procedimentos minimamente invasivos ainda sejam experimentais e necessitem ser plenamente validados, o diagnóstico ecográfico correto e o encaminhamento da paciente para centros terciários com atendimento multidisciplinar de medicina fetal permitem oferecer aumento da sobrevivência de muitas doenças congênitas de evolução fatal.; ABSTRACT About 1% of all pregnancies present structural anomalies. During the last three decades...

Fetal Surgery for Myelomeningocele: Trials and Tribulations

Adzick, N.Scott
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/2012 EN
Relevância na Pesquisa
46.14%
The rationale for in utero repair of myelomeningocele (MMC) in the context of pathologic observations, animal models, and outcomes from the initial experience with human fetal myelomeningocele repair is presented. This has now culminated in a randomized trial, Management of Myelomeningocele Study (the MOMS Trial), the findings of which are listed. The story is focused on the milestone contributions of members of the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia (CHOP) on the road to successful fetal surgery for spina bifida. This is now performed in selected patients and presents an additional therapeutic alternative for expectant mothers carrying a fetus with MMC.