Fetal therapy indonesian experiences
- 2. 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. [email protected] / [email protected]
- 9. IVT
- 10. Survival rate in Rh Isoimmunized Fetuses [email protected] / [email protected]
- 11. Survival for In-Vitro Transfused Hydroponic Fetuses [email protected] / [email protected]
- 12. Pathophysiology of Transfusion To 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%). [email protected] / [email protected]
- 13. Hydrocepha l us
- 14. Fetal Obstructive Hydrocephalus: Distribution by Primary Diagnosis and Survival in 41 Treated Cases [email protected] / [email protected]
- 15. Fetal Obstructive Hydrocephalus: Outcome in 34 Treated Surviving Infants [email protected] / [email protected]
- 16. Fetal Obstructive Hydrocephalus: Relationship of Duration of Treatment to Outcome [email protected] / [email protected]
- 17. Pleural Effusions Hal 315 Tab el 29.1, 29.2
- 21. Antenatal Sonographic Features of Fetuses with Urethral Obstruction [email protected] / [email protected]
- 22. Prognostic Criteria for The Fetus with Bilateral Obstructive Uropathy [email protected] / [email protected]
- 23. 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. [email protected] / [email protected]
- 25. Surgical Interventions 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, [email protected] / migration, and iatrogenic gastroschisis. [email protected]
- 26. 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. [email protected] / [email protected]
- 27. 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 [email protected] / [email protected] procedure
- 28. 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. [email protected] / [email protected]
- 29. 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. [email protected] / [email protected]
- 30. 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 procedures. [email protected] / [email protected]
- 31. Monitoring During Surgery 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 [email protected] / [email protected]
- 32. 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.) [email protected] / [email protected]
- 33. These surgical techniques are considered appropriate for 9 lesions. 1. Obstructive uropathy 2. Hydrocephalus 3. Pleural effusion 4. Twin-To-Twin Transfusion syndrome 5. Amniotic band syndrome 6. Congenital Diaphragmatic Hernia 7. Congenital high airway obstruction syndrome 8. Sacrococcygeal teratoma. 9. Congenital Cystic Adenomatoid Maformartions [email protected] / [email protected]
- 34. Author Experiences “In Indones ia”
- 35. NO Author Procedure D/ Outcome 1. Nurwansyah, Cephalocentesis Hydrocephaly Harapan Kita Gatot AR hospital 2. Nurwansyah, Serial Vesicosentesis PUV Harapan Kita Gatot AR Hospital 3. Nurwansyah, Thoracocentesis Isolated Harapan Kita Gatot AR hydrothorax Hospital 4. Nurwansyah, Paracentesis Isolated Ascites Harapan Kita Gatot AR Hospital 5. Nurwansyah, Amniotic-septostomi TTTS YPK Hospital Trijatmo R. 6. Nurwansyah, IUT Hydropsfoetalis Harapan Kita Gatot AR ec Rh Hospital Incompatibility [email protected] / [email protected]
- 36. NO Author Procedure D/ Outcome 7, Nurwansyah, Amnioinfusion Renal Agenesis bil ASIH Ari Waluyo Maternity Hospital 8. Nurwansyah, IUT Hydrops foetalis ASIH Ari Waluyo, ec. ABO Maternity Indriani Incomptblt Hospital 9. Nurwansyah, IUT Hydrops foetalis / BWCH Uf Bagasi Thallasemia [email protected] / [email protected]