摘要:

Pulmonary hypoplasia is a major problem in infants with congenital diaphragmatic hernia. Intrauterine reparative procedures are associated with a high complication rate. The development of less complex operations to reduce the degree of fetal lung hypoplasia may improve neonatal survival. Our objective was to investigate the effectiveness of an iatrogenic gastroschisis in reducing fetal pulmonary hypoplasia in a sheep model with an artificially created diaphragmatic hernia. A left-sided diaphragmatic hernia (Bochdalek type) was created at 75 days’ gestation in an ovine fetal model during the pseudoglandular phase of lung development. At 110 days’ gestational age, a left-sided gastroschisis was created by excising part of the lower abdominal wall and buttressing the opening with a rubber ring. The fetus remained in utero until 135 days’ gestation, at which time it was sacrificed for autopsy. Histopathologic and morphometric studies were performed on the lungs. Ten animals had creation of a diaphragmatic hernia. Four underwent the second surgery to create a gastroschisis. One animal completed the entire protocol, 3 fetuses aborted after the second surgery. Autopsy confirmed effective decompression of the herniated abdominal contents from the chest into the amniotic cavity in all 4 cases. The lungs of the animal that completed the protocol were appropriately developed, while those fetuses that died soon after gastroschisis creation had severe pulmonary hypoplasia, mainly involving the left lung. Artificially induced diaphragmatic hernia, in the ovine fetus, causes severe pulmonary hypoplasia. An iatrogenic fetal gastroschisis allows the spontaneous decompression of herniated abdominal contents from the thorax, and may permit improved lung develo

ISSN:1015-3837    

DOI:10.1159/000264217

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Our purpose was to assess the feasibility of the endoscopic delivery of surfactant directly to the fetus during active preterm labor. A gassterilized intraoperative fiberscope was introduced through the cervical canal into the amniotic cavity after spontaneous rupture of membranes during preterm labor in 3 patients. The flexible fiberscope was inserted under constant endoscopic visual control to avoid possible trauma to the fetus and the mother. Surfactant was injected into the mouths of 3 preterms fetuses through a catheter placed through the biopsy channel of the fiberscope. Fetal heart rate tracings as well as neonatal and maternal outcome are reported for each case. In utero surfactant placement was successfull in each case. The fetal heart rate remained normal throughout the procedure. No maternal or neonatal complications/infections were detected. Our preliminary experience indicates that in utero endoscopic delivery of surfactant to a preterm human fetus is feasible. The usefulness of intrapartum endoscopy in the prophylactic administration of surfactant directly to the fetus, prior to the first breath, has to be assessed in a prospective controlled study.

ISSN:1015-3837    

DOI:10.1159/000264218

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The in utero diagnosis of fetal myeloproliferative disease was made by cordocentesis following the ultrasound appearance of fetal hepatosplenomegaly and mild hydrops. The 2 fetuses reported both had leukocyte counts greater than 75,000/mm3 with a predominance of blast forms. In both cases the karyotype revealed trisomy 21.

ISSN:1015-3837    

DOI:10.1159/000264219

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The incidence of macrosomic infants weighing 5,000 g or more is rare. We experienced a case of nondiabetic macrosomia, in which the fetus weighed more than 5,000 g. The newborn was diagnosed as having Simpson-Golabi-Behmel syndrome. We discuss antenatal ultrasonographic findings in the case.

ISSN:1015-3837    

DOI:10.1159/000264220

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000264222

出版商:S. Karger AG    

年代:1995

数据来源: Karger