Fetal therapy indonesian experiences

dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com

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

Survival rate in Rh Isoimmunized Fetuses

Survival for In-Vitro Transfused Hydroponic Fetuses

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

Clinical Data Summary

Prognostic Indicator

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

proceduredokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com

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

procedures.dokter_nudi@yahoo.com /

nurwansyah.nudi@gmail.com

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

Serial Vesicosentesis PUV Harapan Kita Hospital

Thoracocentesis Isolated hydrothorax

Harapan Kita Hospital

Paracentesis Isolated Ascites Harapan Kita Hospital

5. Nurwansyah, Trijatmo R.

Amniotic-septostomi TTTS YPK Hospital

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

Terima Kasih

Fetal therapy indonesian experiences

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