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Cite this page: Hill, M.A. (2019, August 24) Embryology Fetal Surgery. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Fetal_Surgery
10 Most Recent Papers
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Advances in maternal fetal medicine practice
J Paediatr Child Health. 2012 Nov;48(11):955-62. doi: 10.1111/j.1440-1754.2012.02596.x.
Tan WS, Guaran R, Challis D. Source MFM, Royal Hospital for Women NSW Pregnancy and Newborn Services Network University of NSW, Sydney, New South Wales, Australia.
Maternal fetal medicine (MFM) is a subspecialty of obstetrics that focuses on identified risk pregnancies. The role includes obstetric ultrasound for fetal assessment and diagnosis of anomalies, invasive prenatal diagnosis and management of pregnancies complicated by maternal medical disorders, multiple fetuses and the antenatal management of extreme prematurity. Skill specialisation within MFM includes fetal interventions such as fetal shunting procedures, intrauterine transfusion, fetoscopic laser photocoagulation of anastomotic vessels for twin to twin transfusion syndrome and ex utero intrapartum treatment. MFM specialists are actively involved in clinical and basic science research to improve maternal and neonatal outcomes. Most Australian MFM specialists are associated with metropolitan teaching hospitals. MFM sub-specialisation has reduced the impact of disability associated with aneuploidy, structural anomalies, multiple pregnancy and extreme prematurity. Management aims are to give families timely counselling, appropriate intervention, and optimisation of the time and location of delivery. The aim of this paper is to update the reader regarding current advances in MFM practices. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Prenatal counseling for cloaca and cloacal exstrophy-challenges faced by pediatric surgeons
Pediatr Surg Int. 2012 Aug;28(8):781-8. doi: 10.1007/s00383-012-3133-3.
Bischoff A, Calvo-Garcia MA, Baregamian N, Levitt MA, Lim FY, Hall J, Peña A. Source Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA. firstname.lastname@example.org
INTRODUCTION: With the advance of prenatal imaging, more often pediatric surgeons are called for prenatal counseling in suspected cases of cloaca or cloacal exstrophy. This presents new challenges for pediatric surgeons since no specific guidelines have been established so far. The purpose of this review is to analyze our experience in prenatally diagnosed cloaca or cloacal exstrophy and to provide some guidelines for prenatal counseling of these complex congenital anomalies. METHODS: A retrospective review of the medical charts of patients with prenatally diagnosed cloaca and cloacal exstrophy who received postnatal care in our institution between July 2005 and March 2012 was performed. Representative images of prenatal studies were selected from 13 cases to illustrate different scenarios and the recommendations given. In addition, a review of the literature was performed to support our advice to parents. RESULTS: Eleven patients were female and two patients were male. The postnatal diagnoses were cloacal exstrophy (6), cloaca (5), posterior cloaca variant (1), and covered cloacal exstrophy (1). The selected abnormal prenatal imaging findings in these 13 patients included hydronephrosis (12), neural tube defect (8), omphalocele (7), lack of meconium at expected rectal location (7), vertebral anomaly (7), non-visualize bladder (5), distended bladder (5), hydrocolpos (4), dilated or echogenic bowel (3), umbilical cord cyst (3), separated pubic bones (2), and the "elephant trunk" sign (2). The prenatal diagnosis was correct in 10 cases, partially correct in two cases, and it was missed in one case. All parents received prenatal counseling depending on the specific diagnosis. CONCLUSION: The continuous technologic innovations in prenatal imaging make it possible to prenatally diagnose more complex anomalies including cloaca and cloacal exstrophy with increased levels of confidence and enhance the benefit of prenatal counseling. Together, these allow the parents to be better prepared for the condition and the care team to provide the best possible initial management in order to improve the outcomes of these challenging patients.
Fetal and maternal analgesia/anesthesia for fetal procedures
Fetal Diagn Ther. 2012;31(4):201-9. doi: 10.1159/000338146. Epub 2012 Apr 25.
Van de Velde M, De Buck F. Source Department of Anesthesiology, University Hospitals Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. email@example.com
For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation. Copyright © 2012 S. Karger AG, Basel.