Fetal therapy indonesian experiences
Transcript of Fetal therapy indonesian experiences
Fetal Therapy: Options and Medical Treatment
Pacemakers In the past two decades, the goal of prenatal diagnosis has
changed from merely deciding about terminating the pregnancy to possible active intervention for improving the
long-term outcome of the fetus. Recently, medical and surgical fetal
therapy has emerged as an option for the management of various fetal
malformations.
IVTIVT
Pathophysiology of TransfusionTo calculate the volume of donor blood necessary to achieve a post-tranfusion fetal hematocrit of 40%, the estimated fwtoplacental blood volume (left, e.g., 100mL at 27 weeks) is multiplied by DF (right, e.g., 0,8 for a pretransfusion fetal hematocrit of 10% and a donor hematocrit of 80%).
HydrocephaHydrocephaluslus
Fetal Obstructive Hydrocephalus: Distribution by Primary Diagnosis and Survival in 41 Treated Cases
Fetal Obstructive Hydrocephalus: Outcome in 34 Treated Surviving Infants
Fetal Obstructive Hydrocephalus: Relationship of Duration of Treatment to Outcome
Pleural Pleural EffusionsEffusions
Hal 315 Tabel 29.1, 29.2
Obstructive Obstructive UropathyUropathy
Antenatal Sonographic Features of Fetuses with Urethral Obstruction
Prognostic Criteria for The Fetus with Bilateral Obstructive Uropathy
Management scheme for the fetus with bilateral hydronephrosis. Note that the development of prognostic criteria based on the assessment of fetal renal function allows improved counseling and management.
Three approaches are currently used for
invasive
A.Ultrasonography-guided vesicoamniotic
and, less commonly, thoracoamniotic shunt
placement, is used in a fetus from 16 weeks'
gestation to when lung maturity makes
postnatal treatment the best option.
Complications are inadequate function,
migration, and iatrogenic gastroschisis.
Surgical Interventions
B. Fetoscopic techniques now have a
clinical application in the ligation of
umbilical cords in acardiac twins, in
selective laser photocoagulation of
communicating vessels in twin-to-
twin transfusions, and in the
ablation of posterior urethral valves.
1. The procedure is performed
inside the uterus using
endoscopes, with a much
smaller hysterotomy than that
needed for open procedures.
This lessens the risks of
preterm labor and fetal
hypothermia and improves fetal
hemostasis during the
2. The success of the procedure depends
on the use of both a transabdominal
ultrasonographic intraoperative view
and a simultaneous endoscopic view
to guide placement of the trocars and
cannulae.
3. The drawbacks of fetoscopic surgery
are the risk of bleeding (avoiding the
transplacental route decreases this
risk), rupture of membranes, and
chorioamnionitis. Fetoscopy may also
be difficult because of poor access to
the fetus due to fetal position or
polyhydramnios.
C. Open fetal surgery is currently
performed at select centers in
instances in which the risk of the
procedure to the mother and fetus is
overridden by a diagnosis with a
known poor outcome. Complications
such as chorioamnionitis, preterm
labor, bleeding, and direct trauma to
the fetus are risks in most of these
The parameters monitored during and after surgery
include the following:
•Myometrial contractions and intrauterine pressures.
• Maternal blood pressure, ECG, and pulse oximetric and blood gas levels.
• Fetal pulse oximetric measurement (50%-60% saturation), heart rate, blood gases, and ECG
Monitoring During Surgery
• Ultrasonographic findings in
cases of fetoscopic surgery
• Fetal temperature (Maintain
temperature with continuous
warm sodium chloride irrigation,
minimized exposure, and
increased ambient temperature.)
Monitoring During Surgery
These surgical techniques are considered
appropriate for 9 lesions.
1. Obstructive uropathy2. Hydrocephalus3. Pleural effusion4. Twin-To-Twin Transfusion syndrome5. Amniotic band syndrome6. Congenital Diaphragmatic Hernia7. Congenital high airway obstruction syndrome8. Sacrococcygeal teratoma.9. Congenital Cystic Adenomatoid Maformartions
Author Author ExperiencesExperiences“In Indonesia”
NO Author Procedure D/ Outcome
1. Nurwansyah, Gatot AR
Cephalocentesis Hydrocephaly Harapan Kita hospital
2. Nurwansyah, Gatot AR
Serial Vesicosentesis PUV Harapan Kita Hospital
3. Nurwansyah, Gatot AR
Thoracocentesis Isolated hydrothorax
Harapan Kita Hospital
4. Nurwansyah, Gatot AR
Paracentesis Isolated Ascites Harapan Kita Hospital
5. Nurwansyah, Trijatmo R.
Amniotic-septostomi TTTS YPK Hospital
6. Nurwansyah, Gatot AR
IUT Hydropsfoetalis ec Rh Incompatibility
Harapan Kita Hospital
NO Author Procedure D/ Outcome
7, Nurwansyah, Ari Waluyo
Amnioinfusion Renal Agenesis bil ASIH Maternity Hospital
8. Nurwansyah, Ari Waluyo, Indriani
IUT Hydrops foetalis ec. ABO Incomptblt
ASIH Maternity Hospital
9. Nurwansyah, Uf Bagasi
IUT Hydrops foetalis / Thallasemia
BWCH
