11.
Prediction of dual survival following fetoscopic laser photocoagulation for twin–twin transfusion syndrome
Krispin, E.; Mustafa, H. J.; Espinoza, J. ...
Ultrasound in obstetrics & gynecology,
April 2023, Letnik:
61, Številka:
4
Journal Article
ABSTRACT
Objective
To develop a model based on factors available at the time of diagnosis of twin–twin transfusion syndrome (TTTS) for predicting the probability of dual twin survival following ...
fetoscopic laser photocoagulation (FLP) using a machine‐learning algorithm.
Methods
This was a retrospective study of data collected at two university‐affiliated tertiary fetal centers between 2012 and 2021. The cohort included monochorionic diamniotic twin pregnancies complicated by TTTS that underwent FLP. Data were stratified based on survival 30 days after delivery, and cases with dual survival were compared to those without dual survival. A random forest machine‐learning algorithm was used to construct a prediction model, and the relative importance value was calculated for each parameter that presented a statistically significant difference between the two study groups and was included in the model. The holdout method was applied to check overfitting of the random forest algorithm. A prediction model for dual twin survival 30 days after delivery was presented based on the test set.
Results
The study included 537 women with monochorionic diamniotic twin pregnancy, of whom 346 (64.4%) had dual twin survival at 30 days after delivery and were compared with 191 (35.6%) cases that had one or no survivors. Univariate analysis demonstrated no differences in demographic parameters between the groups. At the time of diagnosis, the dual‐survival group had lower rates of estimated fetal weight (EFW) < 10th centile for gestational age in the donor twin (56.4% vs 69.4%; P = 0.004), intertwin EFW discordance > 25% (40.8% vs 56.5%; P = 0.001) and anterior placenta (40.5% vs 50.0%; P = 0.034). Comparison of Doppler findings between the two groups demonstrated significant differences in the donor twin, with a lower rate of pulsatility index (PI) > 95th centile in the umbilical artery and ductus venosus and a lower rate of PI < 5th centile in the fetal middle cerebral artery in the dual‐survival group. Relative importance values for each of these six parameters were calculated, allowing the construction of a prediction model with an area under the receiver‐operating‐characteristics curve of 0.916 (95% CI, 0.887–0.946).
Conclusions
We developed a predictive model for dual survival in monochorionic twin pregnancies following FLP for TTTS, which incorporates six variables obtained at the time of diagnosis of TTTS, including donor EFW < 10th centile, intertwin EFW discordance > 25%, anterior placenta and abnormal PI in the umbilical artery, ductus venosus and middle cerebral artery of the donor twin. This clinically applicable tool may improve treatment planning and patient counseling. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
12.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
13.
Fetoscopic laser ablation of placental anastomoses in twin–twin transfusion syndrome using ‘Solomon technique’
Ruano, R.; Rodo, C.; Peiro, J. L. ...
Ultrasound in obstetrics & gynecology,
October 2013, 2013-Oct, 2013-10-00, 20131001, Letnik:
42, Številka:
4
Journal Article
ABSTRACT
Objective
To document perinatal outcomes following use of the ‘Solomon technique’ in the selective photocoagulation of placental anastomoses for severe twin–twin transfusion syndrome (TTTS).
...
Methods
Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls).
Results
Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon‐technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11–53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59–13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia–polycythemia sequence (TAPS) in the Solomon‐technique group.
Conclusions
Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
14.
Cigarette toxicity triggers Leber's hereditary optic neuropathy by affecting mtDNA copy number, oxidative phosphorylation and ROS detoxification pathways
Giordano, L; Deceglie, S; d'Adamo, P ...
Cell death & disease,
12/2015, Letnik:
6, Številka:
12
Journal Article
Leber's hereditary optic neuropathy (LHON), the most frequent mitochondrial disease, is associated with mitochondrial DNA (mtDNA) point mutations affecting Complex I subunits, usually homoplasmic. ...
This blinding disorder is characterized by incomplete penetrance, possibly related to several genetic modifying factors. We recently reported that increased mitochondrial biogenesis in unaffected mutation carriers is a compensatory mechanism, which reduces penetrance. Also, environmental factors such as cigarette smoking have been implicated as disease triggers. To investigate this issue further, we first assessed the relationship between cigarette smoke and mtDNA copy number in blood cells from large cohorts of LHON families, finding that smoking was significantly associated with the lowest mtDNA content in affected individuals. To unwrap the mechanism of tobacco toxicity in LHON, we exposed fibroblasts from affected individuals, unaffected mutation carriers and controls to cigarette smoke condensate (CSC). CSC decreased mtDNA copy number in all cells; moreover, it caused significant reduction of ATP level only in mutated cells including carriers. This implies that the bioenergetic compensation in carriers is hampered by exposure to smoke derivatives. We also observed that in untreated cells the level of carbonylated proteins was highest in affected individuals, whereas the level of several detoxifying enzymes was highest in carriers. Thus, carriers are particularly successful in reactive oxygen species (ROS) scavenging capacity. After CSC exposure, the amount of detoxifying enzymes increased in all cells, but carbonylated proteins increased only in LHON mutant cells, mostly from affected individuals. All considered, it appears that exposure to smoke derivatives has a more deleterious effect in affected individuals, whereas carriers are the most efficient in mitigating ROS rather than recovering bioenergetics. Therefore, the identification of genetic modifiers that modulate LHON penetrance must take into account also the exposure to environmental triggers such as tobacco smoke.
več
Dostopno za:
NUK, UL, UM, UPUK
15.
Learning curves of open and endoscopic fetal spina bifida closure: systematic review and meta‐analysis
Joyeux, L.; De Bie, F.; Danzer, E. ...
Ultrasound in obstetrics & gynecology,
June 2020, Letnik:
55, Številka:
6
Journal Article
ABSTRACTObjectiveThe Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida aperta (SBA). Recently developed alternative ...
techniques may reduce maternal risks without compromising the fetal neuroprotective effects. The aim of this systematic review was to assess the learning curve (LC) of different fetal SBA closure techniques.
MethodsMEDLINE, Web of Science, EMBASE, Scopus and Cochrane databases and the gray literature were searched to identify relevant articles on fetal surgery for SBA, without language restriction, published between January 1980 and October 2018. Identified studies were reviewed systematically and those reporting all consecutive procedures and with postnatal follow‐up ≥ 12 months were selected. Studies were included only if they reported outcome variables necessary to measure the LC, as defined by fetal safety and efficacy. Two authors independently retrieved data, assessed the quality of the studies and categorized observations into blocks of 30 patients. For meta‐analysis, data were pooled using a random‐effects model when heterogeneous. To measure the LC, we used two complementary methods. In the group‐splitting method, competency was defined when the procedure provided results comparable to those in the MOMS trial for 12 outcome variables representing the immediate surgical outcome, short‐term neonatal neuroprotection and long‐term neuroprotection at ≥ 12 months of age. Then, when raw patient data were available, we performed cumulative sum analysis based on a composite binary outcome defining successful surgery. The composite outcome combined four clinically relevant variables for safety (absence of extreme preterm delivery < 30 weeks, absence of fetal death ≤ 7 days after surgery) and efficacy (reversal of hindbrain herniation and absence of any neonatal treatment of dehiscence or cerebrospinal fluid leakage at the closure site).
ResultsOf 6024 search results, 17 (0.3%) studies were included, all of which had low, moderate or unclear risk of bias. Fetal SBA closure was performed using standard hysterotomy (11 studies), mini‐hysterotomy (one study) or fetoscopy by either exteriorized‐uterus single‐layer closure (one study), percutaneous single‐layer closure (three studies) or percutaneous two‐layer closure (one study). Only outcomes for standard hysterotomy could be meta‐analyzed. Overall, outcomes improved significantly with experience. Competency was reached after 35 consecutive cases for standard hysterotomy and was predicted to be achieved after ≥ 57 cases for mini‐hysterotomy and ≥ 56 for percutaneous two‐layer fetoscopy. For percutaneous and exteriorized‐uterus single‐layer fetoscopy, competency was not reached in the 81 and 28 cases available for analysis, respectively, and LC prediction analysis could not be performed.
ConclusionsThe number of cases operated is correlated with the outcome of fetal SBA closure, and the number of operated cases required to reach competency ranges from 35 for standard hysterotomy to ≥ 56–57 for minimally invasive modifications. Our observations provide important information for institutions looking to establish a new fetal center, develop a new fetal surgery technique or train their team, and inform referring clinicians, potential patients and third parties. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Curvas de aprendizaje del cierre de la espina bífida fetal mediante cirugía abierta y endoscópica: revisión sistemática y metaanálisis
Objetivo
El ensayo del Estudio sobre la Gestión del Mielomeningocele (MOMS, por sus siglas en inglés) demostró la seguridad y eficacia de la cirugía fetal abierta para la espina bífida aperta (EBA). Las técnicas alternativas recientemente desarrolladas pueden reducir los riesgos de la madre sin comprometer los efectos neuroprotectores del feto. El objetivo de esta revisión sistemática fue evaluar la curva de aprendizaje (CA) de diferentes técnicas de cierre de la EBA fetal.
Métodos
Se realizaron búsquedas en las bases de datos de MEDLINE, Web of Science, EMBASE, Scopus y Cochrane, así como en la literatura gris, para identificar artículos relevantes sobre cirugía fetal para la EBA, sin restricción de idioma, publicados entre enero de 1980 y octubre de 2018. Se examinaron sistemáticamente los estudios identificados y se seleccionaron los que informaban de todos los procedimientos consecutivos y con seguimiento postnatal ≥12 meses. Los estudios se incluyeron sólo si informaban sobre las variables de resultado necesarias para medir la CA, definidas por la seguridad y la eficacia para el feto. Dos autores recuperaron los datos de forma independiente, evaluaron la calidad de los estudios y clasificaron las observaciones en bloques de 30 pacientes. Para el metaanálisis, los datos se agruparon mediante un modelo de efectos aleatorios cuando fueron heterogéneos. Para medir la CA, se usaron dos métodos complementarios. En el método de división de grupos, la competencia se definió cuando el procedimiento proporcionó resultados comparables a los del ensayo MOMS para 12 variables de resultados que representaban el resultado quirúrgico inmediato, la neuroprotección neonatal a corto plazo y la neuroprotección a largo plazo a ≥12 meses de edad. Luego, cuando se dispuso de los datos brutos de los pacientes, se realizó un análisis de suma acumulada basado en un resultado binario compuesto que definió el éxito de la cirugía. El resultado compuesto combinó cuatro variables clínicamente relevantes en cuanto a la seguridad (ausencia de parto pretérmino extremo <30 semanas; ausencia de muerte fetal a ≤7 días después de la cirugía) y eficacia (reducción de la hernia del rombencéfalo y ausencia de cualquier tratamiento neonatal de dehiscencia o derrame de líquido cefalorraquídeo en el lugar del cierre).
Resultados
De los 6024 resultados de la búsqueda, se incluyeron 17 (0,3%) estudios, todos ellos con un riesgo de sesgo bajo, moderado o incierto. El cierre de la EBA fetal se realizó mediante histerotomía estándar (11 estudios), mini histerotomía (un estudio) o fetoscopia, ya fuera mediante el cierre exteriorizado del útero de una sola capa (un estudio), el cierre percutáneo de una sola capa (tres estudios) o el cierre percutáneo de dos capas (un estudio). Sólo se pudieron metaanalizar los resultados de la histerotomía estándar. En general, los resultados mejoraron significativamente con la experiencia. Se alcanzó la competencia después de 35 casos consecutivos para la histerotomía estándar y se predijo que se alcanzaría después de ≥57 casos para la mini histerotomía y ≥56 para la fetoscopia percutánea de dos capas. En el caso de las fetoscopias percutánea y exteriorizada del útero de una sola capa, no se alcanzó la competencia en los 81 y 28 casos disponibles para el análisis, respectivamente, y no se pudo realizar el análisis de predicción de la CA.
Conclusiones
El número de casos operados está correlacionado con el resultado del cierre de la EBA fetal, y el número de casos operados necesarios para alcanzar la competencia estuvo entre 35 para la histerotomía estándar y ≥56–57 para las operaciones con mínima agresividad. Las observaciones realizadas proporcionan información importante para las instituciones que buscan establecer un nuevo centro fetal, desarrollar una nueva técnica de cirugía fetal o entrenar a su equipo, e informar a los médicos que remiten a especialistas a los posibles pacientes y a terceros. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
摘要
开放式和内窥镜下胎儿脊柱裂闭合术学习曲线:系统回顾和荟萃分析
目标
脊髓膜膨出研究管理(MOMS)试验证明了开放式胎儿手术治疗脊柱裂 (SBA) 的安全性有效性。最近开发的替代技术可以在不损害胎儿神经保护作用的情况下降低孕产妇风险。此次系统回顾旨在评估不同胎儿SBA闭合技术的学习曲线(LC)。
方法
检索了MEDLINE、Web of Science、EMBASE、Scopus和Cochrane数据库以及相关的灰色文献，查找1980年1月至2018年10月之间以任何语言出版的SBA胎儿手术相关文章。系统回顾了甄别出来的几个研究项目，选择了几个报告全部连续程序且术后随访期≥12个月的研究项目。只有当研究报告了根据胎儿安全性有效性定义的测量LC所需的结果变量时，才纳入研究。两位作者独立检索了数据，评估了研究质量，对30例患者进行分组观察。荟萃分析过程中，用一个随机效应模型进行
异构数据汇总。为测量LC，我们应用了两种非主流方法。在分组法中，当程序提供的结果与MOMS试验所得结果类似时，定义了12个结果变量的能力。这些变量表示≥12个月时的即刻手术结果、短期新生儿神经保护和长期神经保护。然后在可以获取病人原始数据时，我们根据决定手术成功与否的复合二元结果进行累积总和分析。综合结果结合了四个临床相关的安全性变量(无30周内极端早产，术后7天内无胎儿死亡)和疗效变量(后脑疝逆转，闭合处无任何新生儿裂开或脑脊液漏治疗)。
结果
在6024个检索结果中，纳入了17(0.3%)项研究。所有这些研究的偏倚风险较低，中度或不明。通过标准的子宫切开术(11项研究)、微型子宫切开术(1项研究)或子宫镜检查，通过室外子宫单层闭合(1项研究)、经皮单层闭合(3项研究)或经皮两层闭合(1项研究)进行胎儿SBA闭合。标准子宫切开术的结果才可以进行荟萃分析。总体而言，随着经验的积累，结果显著改善。连续35例标准子宫切除术后达到合格标准。
预计在微型子宫切开术≥57例，经皮两层胎儿镜检查≥56例后达到相关能力标准。经皮和体外子宫单层宫腔镜检查，分别有可供分析的81例和28例没有达到相关能力标准，无法进行LC预测分析。
结论
手术病例数与胎儿SBA闭合结果相关，
要求达到规定能力的手术病例数量，从标准子宫切开术的35例到微创改造术≥56‐57例不等。我们的观察结果为那些希望建立新的胎儿中心、开发新的胎儿手术技术或培训团队成员，以及临床转诊医生、潜在患者和第三方提供了重要信息。版权 © 2019 ISUOG。由威利父子公司(John Wiley & Sons Ltd)出版。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
16.
Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study
Corroenne, R; Yepez, M; Pyarali, M ...
BJOG : an international journal of obstetrics and gynaecology,
January 2021, 2021-Jan, 2021-01-00, 20210101, Letnik:
128, Številka:
2
Journal Article
Objective
To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB).
Design
Retrospective ...
cohort study.
Setting
Texas Children's Hospital, 2011–2018.
Population
Patients who underwent either prenatal or postnatal OSB repair.
Methods
Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2) and at the last ultrasound before delivery (US3). At birth and at 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as odds ratios (95% confidence intervals, P values).
Results
A total of 127 patients were included: 93 with prenatal repair (51 fetoscopic; 42 open hysterotomy repair) and 34 with postnatal repair. In the prenatal repair group, predictors for intact MF at birth and at 12 months included: absence of clubfeet (OR 11.3, 95% CI 3.2–39.1, P < 0.01; OR 10.8 95% CI 2.4–47.6, P < 0.01); intact MF at US1 (OR 19.7, 95% CI 5.0–76.9, P < 0.01; OR 8.7, 95% CI 2.0–38.7, P < 0.01); intact MF at US2 (OR 22, 95% CI 6.5–74.2, P < 0.01; OR 13.5, 95% 3.0–61.4, P < 0.01); intact MF at US3 (OR 13.7, 95% CI 3.4–55.9, P < 0.01; OR 12.6, 95% CI 2.5–64.3, P < 0.01); and having a flat lesion (OR 11.2, 95% CI 2.4–51.1, P < 0.01; OR 4.1, 95% CI 1.1–16.5, P = 0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (OR 15.2, 95% CI 2.0–113.3, P = 0.03).
Conclusions
The detection of intact MF in utero from mid‐gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair.
Tweetable
Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair.
Tweetable
Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
17.
Visually estimated and calculated blood loss in vaginal and cesarean delivery
Stafford, Irene, MD; Dildy, Gary A., MD; Clark, Steven L., MD ...
American journal of obstetrics and gynecology,
11/2008, Letnik:
199, Številka:
5
Journal Article
Objective The objective of the study was to compare visually estimated blood loss (vEBL) with calculated estimated blood loss (cEBL) according to mode of delivery and degree of perineal laceration. ...
Study Design Pre- and postdelivery hematocrit (HCT) and other variables including vEBL were prospectively recorded into an obstetrical database between January and September 2005. The cEBL was derived by multiplying the calculated pregnancy blood volume (0.75 × {maternal height (inches) × 50 + maternal weight in pounds × 25}) by percent of blood volume lost ({predelivery HCT − postdelivery HCT}/predelivery HCT). cEBL and vEBL were compared according to mode of delivery and degree of perineal laceration. Results There were 677 subjects with complete data. vEBL was statistically different from cEBL between each degree of laceration and between all modes of delivery, demonstrating an underestimation of vEBL with increasing cEBL. Conclusion Improved methods for calculating blood loss include the use of a modified version of the formula used for pregnancy blood volume calculation.
več
Dostopno za:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
18.
Perinatal outcomes of iatrogenic chorioamniotic separation following fetoscopic surgery: systematic review and meta‐analysis
Nassr, A. A.; Hessami, K.; Shazly, S. A. ...
Ultrasound in obstetrics & gynecology,
September 2021, 2021-Sep, 2021-09-00, 20210901, Letnik:
58, Številka:
3
Journal Article
ABSTRACT
Objective
To compare the perinatal outcomes between pregnancies with and those without iatrogenic chorioamniotic separation (iCAS) following fetoscopic intervention.
Methods
We performed a ...
search in PubMed, EMBASE, Scopus, Web of Science and Google Scholar from inception up to December 2020 for studies comparing perinatal outcomes between pregnancies that developed and those that did not develop iCAS after fetoscopic intervention for twin‐to‐twin transfusion syndrome (TTTS), open neural tube defect (ONTD) or congenital diaphragmatic hernia. A random‐effects model was used to pool the mean differences (MD) or odds ratios (OR) and the corresponding 95% CI. The primary outcome was neonatal survival. Secondary outcomes included gestational age (GA) at intervention and at delivery, interval from intervention to delivery and incidence of preterm prelabor rupture of membranes (PPROM) and preterm delivery. The methodological quality of the included studies was evaluated using the Newcastle–Ottawa scale.
Results
The search identified 348 records, of which seven studies (six on fetoscopic laser photocoagulation (FLP) for TTTS and one on fetoscopic repair for ONTD) assessed the perinatal outcomes of pregnancies that developed iCAS after fetoscopic intervention. Given that only one study reported on fetoscopic ONTD repair, the meta‐analysis was limited to TTTS pregnancies and included six studies (total of 1881 pregnancies). Pregnancies that developed iCAS after FLP for TTTS, compared with those that did not, had significantly lower GA at the time of intervention (weeks) (MD, −1.07 (95% CI, −1.89 to −0.24); P = 0.01) and at delivery (weeks) (MD, −1.74 (95% CI, −3.13 to −0.34); P = 0.01) and significantly lower neonatal survival (OR, 0.41 (95% CI, 0.24–0.70); P = 0.001). In addition, development of iCAS after FLP for TTTS increased significantly the risk for PPROM < 34 weeks' gestation (OR, 3.98 (95% CI, 1.76–9.03); P < 0.001) and preterm delivery < 32 weeks (OR, 1.80 (95% CI, 1.16–2.80); P = 0.008).
Conclusions
iCAS is a common complication after FLP for TTTS. In patients undergoing FLP for TTTS, iCAS develops more often with earlier GA at intervention and is associated with earlier GA at delivery, higher risk of PPROM < 34 weeks' gestation and preterm delivery < 32 weeks and lower neonatal survival. Given the limitations of this meta‐analysis and lack of literature reporting on other types of fetoscopic intervention, the presented findings should be interpreted with caution and should not be generalized to fetoscopic procedures used to treat other fetal conditions. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
19.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
20.
Comparison of two fetoscopic open neural tube defect repair techniques: single‐ vs three‐layer closure
Belfort, M. A.; Whitehead, W. E.; Shamshirsaz, A. A. ...
Ultrasound in obstetrics & gynecology,
October 2020, 2020-10-00, 20201001, Letnik:
56, Številka:
4
Journal Article
ABSTRACT
Objectives
We reported previously on an exteriorized‐uterus fetoscopic repair for open neural tube defect (ONTD) using a single‐layer closure (SLC) technique. However, because SLC was ...
associated with a high rate of cerebrospinal fluid (CSF) leakage at birth, we developed a three‐layer closure (3LC) technique comprising a bovine collagen patch, a myofascial layer and a skin layer. The aims of this study were to compare SLC and 3LC in terms of intraoperative, postoperative and obstetric outcomes, as well as short‐term neonatal neurologic and non‐neurologic outcomes.
Methods
This was a retrospective analysis of prospectively collected data, from 32 consecutive SLC controls and 18 consecutive 3LC cases, that underwent exteriorized‐uterus two‐port fetoscopic repair of ONTD at our center, between April 2014 and December 2018. All patients satisfied the Management of Myelomeningocele Study (MOMS) criteria. Obstetric, maternal, fetal and early neonatal outcomes were compared between the SLC and 3LC groups.
Results
Maternal demographics and mean gestational age (GA) at fetal surgery (25.0 ± 0.7 vs 25.0 ± 0.5 weeks' gestation; P = 0.96), and at delivery (36.5 ± 3.5 vs 37.6 ± 3.0 weeks; P = 0.14), were similar between the SLC and 3LC groups, respectively. The rate of preterm prelabor rupture of membranes (PPROM) < 37 weeks (28% vs 29%; P = 0.9), mean GA at PPROM (32.3 ± 3.4 vs 32.7 ± 1.9 weeks; P = 0.83) and rate of vaginal delivery (50% vs 47%; P = 0.84) were similar for the SLC vs 3LC groups, respectively. In pregnancies that had SLC compared with those that had 3LC, there was a significantly higher incidence of CSF leakage at birth (8/32 (25%) vs 0/17 (0%); P = 0.02) and a significantly lower rate of reversal of hindbrain herniation at 6 weeks postoperatively (18/30 (60%) vs 14/15 (93%); P = 0.02). The rate of infants that met the MOMS criteria for shunt placement or died before 12 months of age (23/31 (74%) vs 7/12 (58%); P = 0.31) and those that required treatment for hydrocephalus by 12 months (15/32 (47%) vs 4/12 (33%); P = 0.42) were similar between the SLC and 3LC groups, respectively.
Conclusions
Compared to SLC, 3LC preserves the fetal and obstetric benefits of fetoscopic repair and shows improved rates of CSF leakage and reversal of hindbrain herniation at 6 weeks postoperatively. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Dostopno za:
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