Journal articles: 'Prenatal Surgery'

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Winter, George F. "Prenatal surgery." British Journal of Midwifery 26, no. 1 (January 2, 2018): 60. http://dx.doi.org/10.12968/bjom.2018.26.1.60.

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Halimun, E. M. "Surgery in Perinatology." Paediatrica Indonesiana 35, no. 9-10 (October 8, 2018): 205–10. http://dx.doi.org/10.14238/pi35.9-10.1995.205-10.

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Although modem neonatal surgery is a very young subject, it started only after the second world war, the progress is remarkable. The well intergrated interdisciplinary team among pediatric surgeons, pediatricians, neonatologits, anaesthetists, and other relevant specialists made this progress possible. Neonatal surgrey has been influenced by the advances in prenatal diagnosis. Neonatal surgical emergencies are related to perinatal conditions such as better antenatal care, including ultrasonogram examination, encourage the high risk pregnant women to deliver at pediatric/perinatal centers where obstetricians, pediatricians or neonatologist, pediatric surgeon, anesthetist are working as a team. Prenatal diagnosis has been one of the most challenging aspects in perinatology, and may directly related to the task of the pediatric surgeons to salvage certain type of malformations. Some experience of perinatal surgery is also discussed.

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Peranteau, William H., and N. Scott Adzick. "Prenatal surgery for myelomeningocele." Current Opinion in Obstetrics and Gynecology 28, no. 2 (April 2016): 111–18. http://dx.doi.org/10.1097/gco.0000000000000253.

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Cools, Michael, Weston Northam, William Goodnight, Graham Mulvaney, Scott Elton, and Carolyn Quinsey. "Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair." Neurosurgical Focus 47, no. 4 (October 2019): E14. http://dx.doi.org/10.3171/2019.7.focus19355.

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OBJECTIVEHospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies.METHODSThe medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians.RESULTSA total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group.CONCLUSIONSPatients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.

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Wilson, R. Douglas. "Prenatal evaluation for fetal surgery." Current Opinion in Obstetrics and Gynecology 14, no. 2 (April 2002): 187–93. http://dx.doi.org/10.1097/00001703-200204000-00013.

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Arensman, Robert M. "Prenatal Diagnosis." Journal of the American College of Surgeons 204, no. 1 (January 2007): A36. http://dx.doi.org/10.1016/j.jamcollsurg.2006.10.020.

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Paek, Bettina, James D. Goldberg, and Craig T. Albanese. "Prenatal Diagnosis." World Journal of Surgery 27, no. 1 (January 1, 2003): 27–37. http://dx.doi.org/10.1007/s00268-002-6734-5.

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Riley, John S., Ryan M. Antiel, Alan W. Flake, Mark P. Johnson, Natalie E. Rintoul, John D. Lantos, Michael D. Traynor, N. Scott Adzick, Chris Feudtner, and Gregory G. Heuer. "Pediatric neurosurgeons’ views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey." Neurosurgical Focus 47, no. 4 (October 2019): E8. http://dx.doi.org/10.3171/2019.7.focus19406.

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OBJECTIVEThe Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons’ risk tolerance affected their views, how their views compare to those of their colleagues in other specialties, and how their management of hydrocephalus compares to the guidelines used in the MOMS trial.METHODSA cross-sectional survey was sent to all 154 pediatric neurosurgeons in the American Society of Pediatric Neurosurgeons. The effect of surgeons’ risk tolerance on opinions and counseling of prenatal closure was determined by using ordered logistic regression.RESULTSCompared to postnatal closure, 71% of responding pediatric neurosurgeons viewed prenatal closure as either “very favorable” or “somewhat favorable,” and 51% reported being more likely to recommend prenatal surgery in light of MOMS. Compared to pediatric surgeons, neonatologists, and maternal-fetal medicine specialists, pediatric neurosurgeons viewed prenatal MMC repair less favorably (p < 0.001). Responders who believed the surgical risks were high were less likely to view prenatal surgery favorably and were also less likely to recommend prenatal surgery (p < 0.001). The management of hydrocephalus was variable, with 60% of responders using endoscopic third ventriculostomy in addition to ventriculoperitoneal shunts.CONCLUSIONSThe majority of pediatric neurosurgeons have a favorable view of prenatal surgery for MMC following MOMS, although less so than in other specialties. The reported acceptability of surgical risks was strongly predictive of prenatal counseling. Variation in the management of hydrocephalus may impact outcomes following prenatal closure.

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SPLETE, HEIDI. "Prenatal Spinal Surgery Improves Brain Function." Clinical Neurology News 7, no. 3 (March 2011): 13. http://dx.doi.org/10.1016/s1553-3212(11)70049-8.

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Au-Yeung, Jeff Ying-Kit, and Kwong-Leung Chan. "Prenatal Surgery for Congenital Diaphragmatic Hernia." Asian Journal of Surgery 26, no. 4 (October 2003): 240–43. http://dx.doi.org/10.1016/s1015-9584(09)60314-6.

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Lapa, Denise Araujo. "Prenatal superior to postnatal myelomeningocele surgery." Journal of Pediatrics 198 (July 2018): 322–25. http://dx.doi.org/10.1016/j.jpeds.2018.04.060.

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Tulipan, Noel, John C. Wellons, Elizabeth A. Thom, Nalin Gupta, Leslie N. Sutton, Pamela K. Burrows, Diana Farmer, et al. "Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement." Journal of Neurosurgery: Pediatrics 16, no. 6 (December 2015): 613–20. http://dx.doi.org/10.3171/2015.7.peds15336.

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OBJECT The Management of Myelomeningocele Study (MOMS) was a multicenter randomized trial comparing the safety and efficacy of prenatal and postnatal closure of myelomeningocele. The trial was stopped early because of the demonstrated efficacy of prenatal surgery, and outcomes on 158 of 183 pregnancies were reported. Here, the authors update the 1-year outcomes for the complete trial, analyze the primary and related outcomes, and evaluate whether specific prerandomization risk factors are associated with prenatal surgery benefit. METHODS The primary outcome was a composite of fetal loss or any of the following: infant death, CSF shunt placement, or meeting the prespecified criteria for shunt placement. Primary outcome, actual shunt placement, and shunt revision rates for prenatal versus postnatal repair were compared. The shunt criteria were reassessed to determine which were most concordant with practice, and a new composite outcome was created from the primary outcome by replacing the original criteria for CSF shunt placement with the revised criteria. The authors used logistic regression to estimate whether there were interactions between the type of surgery and known prenatal risk factors (lesion level, gestational age, degree of hindbrain herniation, and ventricle size) for shunt placement, and to determine which factors were associated with shunting among those infants who underwent prenatal surgery. RESULTS Ninety-one women were randomized to prenatal surgery and 92 to postnatal repair. The primary outcome occurred in 73% of infants in the prenatal surgery group and in 98% in the postnatal group (p < 0.0001). Actual rates of shunt placement were only 44% and 84% in the 2 groups, respectively (p < 0.0001). The authors revised the most commonly met criterion to require overt clinical signs of increased intracranial pressure, defined as split sutures, bulging fontanelle, or sunsetting eyes, in addition to increasing head circumference or hydrocephalus. Using these modified criteria, only 3 patients in each group met criteria but did not receive a shunt. For the revised composite outcome, there was a difference between the prenatal and postnatal surgery groups: 49.5% versus 87.0% (p < 0.0001). There was also a significant reduction in the number of children who had a shunt placed and then required a revision by 1 year of age in the prenatal group (15.4% vs 40.2%, relative risk 0.38 [95% CI 0.22–0.66]). In the prenatal surgery group, 20% of those with ventricle size < 10 mm at initial screening, 45.2% with ventricle size of 10 up to 15 mm, and 79.0% with ventricle size ≥ 15 mm received a shunt, whereas in the postnatal group, 79.4%, 86.0%, and 87.5%, respectively, received a shunt (p = 0.02). Lesion level and degree of hindbrain herniation appeared to have no effect on the eventual need for shunting (p = 0.19 and p = 0.13, respectively). Similar results were obtained for the revised outcome. CONCLUSIONS Larger ventricles at initial screening are associated with an increased need for shunting among those undergoing fetal surgery for myelomeningocele. During prenatal counseling, care should be exercised in recommending prenatal surgery when the ventricles are 15 mm or larger because prenatal surgery does not appear to improve outcome in this group. The revised criteria may be useful as guidelines for treating hydrocephalus in this group.

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Morini, Francesco, Augusto Zani, Andrea Conforti, Ernest van Heurn, Simon Eaton, Prem Puri, Risto Rintala, et al. "Current Management of Congenital Pulmonary Airway Malformations: A “European Pediatric Surgeons' Association” Survey." European Journal of Pediatric Surgery 28, no. 01 (July 14, 2017): 001–5. http://dx.doi.org/10.1055/s-0037-1604020.

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Aim To define current management of congenital pulmonary airway malformation (CPAM). Methods A total of 181 European Pediatric Surgeons' Association members (91% senior) from 48 countries completed an online questionnaire. Main Results Prenatal: 93% respondents work in centers with prenatal diagnosis facilities, and 27% in centers offering in utero surgery. Prenatal counseling is performed by 86% respondents, 22% of whom see >10 cases per year. Risk of single pre-/postnatal complications is deemed low (<5%) by more than 60% of respondents. Eighty-six percent respondents do not offer pregnancy termination for prenatally diagnosed CPAM. Fetal hydrops is the most frequent indication for termination (87%), followed by parental willingness (52%). Prenatal surgery is an option for 44% respondents, preferring thoracoamniotic shunt (82%).Postnatal: 75% respondents operate on asymptomatic patients, 18% before 6 months of age, 62% between 6 and 12 months of age, and 20% after 12 months of age. Risk of infection (86%), cancer (63%), and symptoms development (62%) are indications for surgery in asymptomatic CPAM. Sixty-three percent prefer a thoracotomy. Lobectomy is the preferred procedure (58% respondents). Motivations against surgery include lesion <1 cm (64%), risk of postoperative complications (37%), and lack of evidence favoring surgery (27%). Seventeen percent respondents have seen at least one patient with CPAM with lung cancer, in 89% of the cases within the CPAM. Of all the respondents, 83% and 22% offered dedicated follow-up and genetic screening, respectively. Conclusion Current pre- and postnatal management of CPAM lacks uniformity, particularly for surgical indication, timing, and approach. Efforts should be made toward standardization. Risk of CPAM-associated cancer is not clear.

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Gottschalk, Ingo, Judith S. Abel, Tina Menzel, Ulrike Herberg, Johannes Breuer, Ulrich Gembruch, Annegret Geipel, Konrad Brockmeier, Christoph Berg, and Brigitte Strizek. "Prenatal diagnosis, associated findings and postnatal outcome of fetuses with double outlet right ventricle (DORV) in a single center." Journal of Perinatal Medicine 47, no. 3 (April 24, 2019): 354–64. http://dx.doi.org/10.1515/jpm-2018-0316.

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Abstract Objective To assess the spectrum of associated anomalies, the intrauterine course, postnatal outcome and management of fetuses with double outlet right ventricle (DORV). Methods All cases of DORV diagnosed prenatally over a period of 8 years were retrospectively collected in a single tertiary referral center. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. Results Forty-six cases of DORV were diagnosed prenatally. The mean gestational age at first diagnosis was 21+4 weeks (range, 13–37). A correct prenatal diagnosis of DORV was made in 96.3% of the cases. If the relation of the great arteries, the position of the ventricular septal defect (VSD) and additional cardiac anomalies are taken into account, the prenatal diagnosis was correct in 92.6% of the cases. One case was postnatally classified as transposition of the great arteries with subpulmonary VSD and was excluded from further analysis. A total of 41 (91.1%) fetuses with DORV had major additional cardiac anomalies, 30 (66.7%) had extracardiac anomalies and 13 (28.9%) had chromosomal or syndromal anomalies. Due to their complex additional anomalies, five (11.1%) of our 45 fetuses had multiple malformations and were highly suspicious for non-chromosomal genetic syndromes, although molecular diagnosis could not be provided. Disorders of laterality occurred in 10 (22.2%) fetuses. There were 17 terminations of pregnancy (37.8%), two (4.4%) intrauterine and seven (15.6%) postnatal deaths. Nineteen of 22 (86.4%) live-born children with an intention to treat were alive at last follow-up. The mean follow-up among survivors was 32 months (range, 2–72). Of 21 children who had already undergone postnatal surgery, eight (38.1%) achieved biventricular repair and 13 (61.9%) received univentricular palliation. One recently born child is still waiting for surgery. All children predicted prenatally to need a single ventricle palliation, and all children predicted to achieve biventricular repair, ultimately received the predicted type of surgery. After surgery, 14 of 18 (77.8%) children were healthy without any impairment. Conclusion DORV is a rare and often complex cardiac anomaly that can be diagnosed prenatally with high precision. DORV is frequently associated with major additional anomalies, leading to a high intrauterine and postnatal loss rate due to terminations or declined postnatal therapy. Without additional anomalies, the prognosis is good, although approximately 60% of children will have single ventricle palliation.

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Gadjradj, Pravesh S., Jochem K. H. Spoor, Alex J. Eggink, René Wijnen, Jena L. Miller, Mara Rosner, Mari L. Groves, et al. "Neurosurgeons’ opinions on the prenatal management of myelomeningocele." Neurosurgical Focus 47, no. 4 (October 2019): E10. http://dx.doi.org/10.3171/2019.7.focus19362.

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OBJECTIVEImprovements in imaging and surgical technological innovations have led to the increasing implementation of fetal surgical techniques. Open fetal surgery has demonstrated more favorable clinical outcomes in children born with open myelomeningocele (MMC) than those following postnatal repair. However, primarily because of maternal risks but also because of fetal risks, fetal surgery for MMC remains controversial. Here, the authors evaluated the contemporary management of MMC in the hope of identifying barriers and facilitators for neurosurgeons in providing fetal surgery for MMC.METHODSAn online survey was emailed to members of the Congress of Neurological Surgeons (CNS) and the International Society for Pediatric Neurosurgery (ISPN) in March 2019. The survey focused on 1) characteristics of the respondents, 2) the practice of counseling on and managing prenatally diagnosed MMC, and 3) barriers, facilitators, and expectations of fetal surgery for MMC. Reminders were sent to improve the response rate.RESULTSA total of 446 respondents filled out the survey, most (59.2%) of whom specialized in pediatric neurosurgery. The respondents repaired an average of 9.6 MMC defects per year, regardless of technique. Regardless of the departments in which respondents were employed, 91.0% provided postnatal repair of MMC, 13.0% open fetal repair, and 4.9% fetoscopic repair. According to the surgeons, the most important objections to performing open fetal surgery were a lack of cases available to become proficient in the technique (33.8%), the risk of maternal complications (23.6%), and concern for fetal complications (15.2%). The most important facilitators according to advocates of prenatal closure are a decreased rate of shunt dependency (37.8%), a decreased rate of hindbrain herniation (27.0%), and an improved rate of motor function (18.9%). Of the respondents, only 16.9% agreed that open fetal surgery should be the standard of care.CONCLUSIONSThe survey results showed diversity in the management of patients with MMC. In addition, significant diversity remains regarding fetal surgery for MMC closure. Despite the apparent benefits of open fetal surgery in selected pregnancies, only a minority of centers and providers offer this technique. As a more technically demanding technique that requires multidisciplinary effort with less well-established long-term outcomes, fetoscopic surgery may face similar limited implementation, although the surgery may pose fewer maternal risks than open fetal surgery. Centralization of prenatal treatment to tertiary care referral centers, as well as the use of sophisticated training models, may help to augment the most commonly cited objection to the implementation of prenatal closure, which is the overall limited caseload.

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&NA;. "NewsCAP: Prenatal surgery is better than postnatal surgery for myelomeningocele." AJN, American Journal of Nursing 111, no. 5 (May 2011): 17. http://dx.doi.org/10.1097/01.naj.0000398039.62180.4e.

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De Ponte, Francesco Saverio, Davide Johan Bottini, Eugenio Maggi, Emanuele Marchetti, Piero Cascone, and Giorgio lannetti. "Prenatal Diagnosis." Journal of Craniofacial Surgery 9, no. 2 (March 1998): 190–95. http://dx.doi.org/10.1097/00001665-199803000-00020.

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Bellieni, Carlo V., M. Tei, G. Stazzoni, S. Bertrando, S. Cornacchione, and G. Buonocore. "Use of fetal analgesia during prenatal surgery." Journal of Maternal-Fetal & Neonatal Medicine 26, no. 1 (September 27, 2012): 90–95. http://dx.doi.org/10.3109/14767058.2012.718392.

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Dykes, Evelyn H., and Ross M. Fisher. "Impact of prenatal diagnosis on neonatal surgery." Seminars in Neonatology 1, no. 3 (August 1996): 177–84. http://dx.doi.org/10.1016/s1084-2756(96)80035-2.

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Burbige, Kevin A. "Prenatal Adrenal Hemorrhage Confirmed by Postnatal Surgery." Journal of Urology 150, no. 6 (December 1993): 1867–69. http://dx.doi.org/10.1016/s0022-5347(17)35917-7.

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Bellieni, Carlo V., Silvia Vannuccini, and Felice Petraglia. "Is fetal analgesia necessary during prenatal surgery?" Journal of Maternal-Fetal & Neonatal Medicine 31, no. 9 (April 16, 2017): 1241–45. http://dx.doi.org/10.1080/14767058.2017.1311860.

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Deeney, Scott, and Stig Somme. "Prenatal consultation for foetal anomalies requiring surgery." Women and Birth 29, no. 1 (February 2016): e1-e7. http://dx.doi.org/10.1016/j.wombi.2015.08.004.

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Lakhoo, Kokila. "Introductory editorial: Prenatal diagnosis and fetal surgery." Early Human Development 88, no. 1 (January 2012): 1. http://dx.doi.org/10.1016/j.earlhumdev.2011.11.005.

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Holcomb, George W. "Prenatal adrenal hemorrhage confirmed by postnatal surgery." Journal of Pediatric Surgery 29, no. 5 (May 1994): 711. http://dx.doi.org/10.1016/0022-3468(94)90770-6.

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Kadagad, Poornima, Pascal Pinto, and Rajesh Powar. "Attitudes of pregnant women and mothers of children with orofacial clefts toward prenatal diagnosis of nonsyndromic orofacial clefts in a semiurban set-up in India." Indian Journal of Plastic Surgery 44, no. 03 (September 2011): 489–93. http://dx.doi.org/10.1055/s-0039-1699524.

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ABSTRACT Objectives: To assess the attitudes of pregnant women and mothers of children with orofacial clefts toward prenatal diagnosis of clefts and elective termination of pregnancy, and to investigate their opinion about who makes reproductive decisions in the family. Design: Two hundred subjects were included in the study prospectively regarding hypothetical prenatal ultrasound diagnosis of clefts. Setting: The study was done in a private tertiary care institution and a teaching hospital. Subjects/Participants: One hundred pregnant women consulting the Obstetrics department and 100 mothers of children with orofacial clefts in the Cleft and Craniofacial Unit were selected. Materials and Methods: Group I subjects were interviewed using a questionnaire and were shown preoperative and postoperative pictures of children treated for cleft lip and palate. Group II subjects were interviewed using a questionnaire. Results: Only 3% of Group I subjects and 2% of Group II opined that they would choose the elective termination of pregnancy if the fetus was diagnosed with a cleft on an ultrasound scan. In Group II, 70% subjects wished to have known about pregnancy affected with cleft prenatally and 96% said they would definitely avail ultrasound scans to determine pregnancy affected by clefts in future. Conclusions: Majority of the respondents from both the groups chose to continue with the pregnancy affected with a cleft when questioned regarding hypothetical prenatal ultrasound diagnosis of the cleft.

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Pierro, Agostino, and Aodhnait Fahy. "A Systematic Review of Prenatally Diagnosed Intra-abdominal Enteric Duplication Cysts." European Journal of Pediatric Surgery 29, no. 01 (September 18, 2018): 068–74. http://dx.doi.org/10.1055/s-0038-1668576.

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Introduction With improvements in prenatal ultrasound, more abdominal enteric duplication cysts (EDCs) are diagnosed prenatally. The optimal time for operative intervention is unclear. We aimed to review the evidence supporting the indication and timing of surgery for prenatally diagnosed EDCs. Materials and Methods A systematic review was performed using a defined search strategy identifying articles with inclusion criteria of prenatal diagnosis of histologically confirmed EDCs. Outcomes included (1) indications for resection (symptoms vs. prophylactic) and (2) time from birth to operative intervention. Results Of 1,590 articles screened, prenatal diagnosis of histologically confirmed EDCs was made in 68 articles, detailing indications and timing for resection for 86 patients. Thirty-five patients (41%) became symptomatic early and were resected promptly at a median of 2 days of age. Indications for intervention included bowel obstruction, volvulus, bleeding, recurrent pain and diagnostic dilemma (concern for cystic neuroblastoma). There were 51 patients (59%) who were resected prophylactically at a median of 90 days of age without interval symptoms. Symptomatic cysts had a larger mean cyst diameter. There was a difference in the anatomic distribution of asymptomatic or symptomatic EDCs–gastric duplications were more frequently asymptomatic while jejunal, proximal ileal and colonic duplications were more frequently symptomatic. Conclusion The optimal approach to EDCs diagnosed prenatally is not supported by strong evidence in the literature. Our systematic review indicates that almost half of the infants diagnosed prenatally become symptomatic early and are resected. In asymptomatic patients, close observation and delayed prophylactic resection in infancy can be considered.

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Zvanca, Mona, and Cristian Andrei. "Prenatal Diagnosis of Neuroblastoma." Donald School Journal of Ultrasound in Obstetrics and Gynecology 8, no. 3 (2014): 321–27. http://dx.doi.org/10.5005/jp-journals-10009-1371.

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ABSTRACT Fetal malignancies are rare complications during pregnancies, but when they appear, they are very challenging for the perinatology team. Because of their low incidence, the information is limited, with data provided from individual case reports or small case series. Although neuroblastoma is the most frequent extracranial solid tumor in childhood, prenatal diagnosis by ultrasound is very rare and almost always discovered during routine third trimester ultrasound. Expectant management is usually indicated prenatally, with serial ultrasound examination. Delivery should be planned in a tertiary center together with pediatric oncologists and surgeons to allow appropriate postnatal management. We present two cases of neuroblastoma diagnosed at 36 and 33 weeks of gestation with multiple aspects of this tumor identified by ultrasound. Both cases needed surgery and had a favorable outcome. The key role of ultrasound in diagnosis and follow-up of neuroblastoma in pregnancy is discussed, together with the management options recommended in literature. How to cite this article Andrei C, Vladareanu R, Zvanca M, Vladareanu S. Prenatal Diagnosis of Neuroblastoma. Donald School J Ultrasound Obstet Gynecol 2014;8(3):321-327.

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Mesas Burgos, Carmen, Jenny Hammarqvist-Vejde, Björn Frenckner, and Peter Conner. "Differences in Outcomes in Prenatally Diagnosed Congenital Diaphragmatic Hernia Compared to Postnatal Detection: A Single-Center Experience." Fetal Diagnosis and Therapy 39, no. 4 (October 3, 2015): 241–47. http://dx.doi.org/10.1159/000439303.

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Objectives: To compare outcomes in pregnancies with a prenatal detection of congenital diaphragmatic hernia (CDH) with children diagnosed after birth, treated at the same institution, and to determine the ability to predict prognosis through measurements of the observed to expected lung-to-head ratio (O/E LHR). Methods: This is a retrospective review of all children with CDH treated at our institution during 2006-2014. We compared outcomes of infants referred for surgery after postnatal diagnosis with outcomes of infants with prenatally diagnosed CDH. Results: In the prenatal group, O/E LHR was significantly different between survivors and deceased patients, with a cutoff at 35% O/E LHR. Survival to discharge and 1-year survival were significantly higher in the postnatal group that required intubation within 24 h; i.e., 92 and 89% versus 85 and 73% in the prenatal group (p < 0.05). There was less need for extracorporeal membrane oxygenation (ECMO), 41 versus 60%, and patch, 41 versus 75% (p < 0.001), in the postnatal group with early diagnosis compared with the prenatal group, respectively. Conclusion: Children with prenatally diagnosed CDH represent a population with a more severe condition compared to infants diagnosed after birth. They have poorer outcomes with higher needs for ECMO or use of patch, and lower survival rates were observed at an O/E LHR below 35%.

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Kiener, Teresa Antonia, Christoph Wohlmuth, Christa Schimke, Martha Georgina Brandtner, and Dagmar Wertaschnigg. "Ultrasound Markers in Fetal Hydronephrosis to Predict Postnatal Surgery." Ultraschall in der Medizin - European Journal of Ultrasound 41, no. 03 (July 5, 2018): 278–85. http://dx.doi.org/10.1055/a-0591-3303.

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Abstract Purpose Parents confronted with the finding of antenatal hydronephrosis (ANH) are particularly interested in whether their baby will need postnatal surgery. The objective of this study was to predict ANH requiring surgery on the basis of the fetal anteroposterior renal pelvic diameter (APRPD) and the Society for Fetal Urology (SFU) grading system. Materials and Methods The medical records of 179 patients with the finding of ANH were reviewed retrospectively. ANH was graded according to the SFU grading system. Prenatal ultrasound examinations were correlated to postnatal outcome, which was divided into three groups: prenatal resolution, conservative management and surgical treatment. Results 58 (32.4 %) cases were classified as prenatal resolution, 89 (49.7 %) babies were assigned to the conservative outcome group and 32 (17.9 %) patients needed surgical repair. Postnatal surgery was best predicted in the second trimester (area under the receiver operating characteristics curve: 0.839) by an APRPD cut-off of 8.3 mm (sensitivity: 77.8 %; specificity: 85.7 %; PPV of 53.9 %, NPV of 94.7 %). The combination of the parameters “progression of SFU grade” and SFU grade 3 or 4 achieved a sensitivity of 84.4 % and a specificity of 80.3 % for the prediction of surgery. Conclusion Second-trimester APRPD is a useful parameter for predicting the risk for postnatal surgery. The SFU grade should be assessed in every prenatal ultrasound examination as some further risk estimates can be made based on its dynamics over time.

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Nakamura, Manabu, Keisuke Ishii, Masaharu Murata, Jun Sasahara, and Nobuaki Mitsuda. "Postnatal Outcome in Cases of Prenatally Diagnosed Fetal Ovarian Cysts under Conservative Prenatal Management." Fetal Diagnosis and Therapy 37, no. 2 (August 1, 2014): 129–34. http://dx.doi.org/10.1159/000365146.

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Aim: To evaluate the outcome of cases of prenatally diagnosed fetal ovarian cyst under conservative prenatal management. Methods: This retrospective cohort study included patients diagnosed between January 2005 and August 2013. They were managed expectantly during pregnancy and followed up until spontaneous regression of the cyst or postnatal surgery. The outcomes of fetal ovarian cysts were compared combined appearance as being simple or complex at prenatal scan and maximum size of cysts ≥40 or <40 mm. Results: There were 33 study cases. Prenatally 3/33 cases (9%) had spontaneous cyst regression during pregnancy. 14 cysts (42%) were treated surgically, of which torsion was confirmed in 4 (29%). Another 14/33 cases (42%) regressed spontaneously under conservative management after birth. The ovaries could be preserved in 28 patients (85%). The incidence of torsion between complex cysts and simple cysts was not statistically different. The incidence of torsion between patients with cyst size ≥40 and <40 mm was similar. Conclusions: The ovaries could be preserved in approximately 85% of patients under conservative management. The present study could not reveal the significance of prenatal ultrasonographic findings of fetal ovarian cyst for predicting the outcome of patients' ovaries.

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Caplinger, Patty, Ann T. Cooney, Christy Bledsoe, Patricia Hagan, Audra Smith, Paulette Whitfield, Elizabeth Goodridge, JuHee Song, and Phyllis Hart Tipton. "Breastfeeding Outcomes Following Bariatric Surgery." Clinical Lactation 6, no. 4 (November 2015): 144–52. http://dx.doi.org/10.1891/2158-0782.6.4.144.

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The number of bariatric procedures has increased dramatically in recent years because of rising obesity rates in the United States. Because many undergoing this procedure are women of childbearing age, weight loss not only provides them better health outcomes in pregnancy but also presents challenges. Guidelines are needed for women of childbearing age considering pregnancy who are undergoing bariatric procedures and desire to breastfeed their infants. Findings from this retrospective study suggest that pregnant postbariatric women would benefit from high-risk prenatal clinic referrals to address supplemental needs. Prenatal referrals to lactation consultants and registered dietitians for improved nutritional status and better breastfeeding preparation may improve breastfeeding outcomes for the dyad. Referrals to dietitians and lactation consultants may provide continuity of care throughout the childbearing year including the early part of the infant’s life.

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Shah, Amin, Nobutoshi Matsumura, Anita Quon, Jude S. Morton, Jason R. B. Dyck, and Sandra T. Davidge. "Cardiovascular susceptibility to in vivo ischemic myocardial injury in male and female rat offspring exposed to prenatal hypoxia." Clinical Science 131, no. 17 (August 10, 2017): 2303–17. http://dx.doi.org/10.1042/cs20171122.

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Intrauterine growth restriction (IUGR) following prenatal hypoxia exposure leads to a higher risk of developing cardiovascular disease (CVD) in later life. Our aim was to evaluate cardiac susceptibility and its pathophysiological mechanisms following acute myocardial infarction (MI) in adult rat offspring exposed to prenatal hypoxia. Male and female rat offspring, which experienced normoxia (21% O2) or hypoxia (11% O2) in utero underwent sham or MI surgery at 12 weeks of age. Echocardiographic data revealed that both sexes had systolic dysfunction following MI surgery, independent of prenatal hypoxia. Male offspring exposed to prenatal hypoxia, however, had left ventricular dilatation, global dysfunction, and signs of diastolic dysfunction following MI surgery as evident by increased left ventricular internal diameter (LVID) during diastole (MI effect, P<0.01), Tei index (MI effect, P<0.001), and E/E′ ratio (prenatal hypoxia or MI effect, P<0.01). In contrast, diastolic dysfunction in female offspring was not as evident. Cardiac superoxide levels increased only in prenatal hypoxia exposed male offspring. Cardiac sarcoendoplasmic reticulum Ca2+-ATPase2a (SERCA2a) levels, a marker of cardiac injury and dysfunction, decreased in both male and female MI groups independent of prenatal hypoxia. Prenatal hypoxia increased cardiac ryanodine receptor 2 (RYR2) protein levels, while MI reduced RYR2 in only male offspring. In conclusion, male offspring exposed to prenatal hypoxia had an increased susceptibility to ischemic myocardial injury involving cardiac phenotypes similar to heart failure involving diastolic dysfunction in adult life compared with both offspring from healthy pregnancies and their female counterparts.

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Tsao, KuoJen, and Craig T. Albanese. "Prenatal Therapy for Obstructive Uropathy." World Journal of Surgery 27, no. 1 (January 1, 2003): 62–67. http://dx.doi.org/10.1007/s00268-002-6738-1.

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Nuñez-Castruita, Alfredo, Norberto López-Serna, and Santos Guzmán-López. "Prenatal Development of the Maxillary Sinus." Otolaryngology–Head and Neck Surgery 146, no. 6 (January 20, 2012): 997–1003. http://dx.doi.org/10.1177/0194599811435883.

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Objective. To review the prenatal development of the maxillary sinus under the perspective of the sinus surgery. Study Design. Cross-sectional study. Setting. Basic embryology laboratory. Subjects and Methods. Morphometry and morphology of the maxillary sinus and its ostium were studied under stereomicroscopy in 100 human fetuses from the 9th to the 37th week. Fetuses were obtained from the Fetal Collection of the School of Medicine of the Universidad Autónoma de Nuevo León. Approval was granted by the Ethics Committee. Statistics were applied. Results. The maxillary sinus begins its development at the 10th week. On the 37th week, the anterior-posterior diameter has a mean of 4.36 mm; ossification of the medial wall was absent, and the floor was located below the attachment of the inferior turbinate. Septa and recesses were temporarily observed. Some variations in shape were observed; however, only the oval shape persisted. Maxillary sinus hypoplasia was not found, although asymmetry was present in 30% of cases. The ostium was located at the anterior third of the ethmoid infundibulum; its final dimensions were 1.96 mm in length and 0.44 mm in width. The mean length between the ostium to the lamina papyracea and nasolacrimal duct was 1 mm. One case of double maxillary sinus was observed. Significant difference between the variables, in accordance with the age, was found ( P = .02). Conclusion. Knowledge of prenatal development of the maxillary sinus improves the perspective of the sinus surgeon and helps the understanding of postnatal anatomy, especially in children.

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Coleman, Alan, Beth Kline-Fath, Sundeep Keswani, and Foong-Yen Lim. "Prenatal solid tumor volume index: novel prenatal predictor of adverse outcome in sacrococcygeal teratoma." Journal of Surgical Research 184, no. 1 (September 2013): 330–36. http://dx.doi.org/10.1016/j.jss.2013.05.029.

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Mon, Rodrigo A., Marjorie C. Treadwell, Deborah R. Berman, Lori Day, Jeannie Kreutzman, George B. Mychaliska, and Erin E. Perrone. "Outcomes of fetuses with primary hydrothorax that undergo prenatal intervention (prenatal intervention for hydrothorax)." Journal of Surgical Research 221 (January 2018): 121–27. http://dx.doi.org/10.1016/j.jss.2017.08.034.

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AYDIN, Emrah. "Current Approach for Prenatally Diagnosed Congenital Anomalies That Requires Surgery." Turkiye Klinikleri Journal of Gynecology and Obstetrics 27, no. 4 (2017): 193–99. http://dx.doi.org/10.5336/gynobstet.2016-53316.

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Puri, Prem. "The status of prenatal diagnosis and fetal surgery." Journal of Pediatric Surgery 23, no. 5 (May 1988): 491. http://dx.doi.org/10.1016/s0022-3468(88)80455-x.

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Beuriat, Pierre-Aurelien, Isabelle Poirot, Frederic Hameury, Delphine Demede, Kieron J. Sweeney, Alexandru Szathmari, Federico Di Rocco, and Carmine Mottolese. "Low level myelomeningoceles: do they need prenatal surgery?" Child's Nervous System 35, no. 6 (March 27, 2019): 957–63. http://dx.doi.org/10.1007/s00381-019-04123-1.

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Pop-Trajkovic, Sonja, Aleksandar Ljubic, Vesna Kopitovic, Vladimir Antic, Jelena Milosevic, and Milan Trenkic. "Fetal multicystic kidney disease: Outcome and follow up." Medical review 63, no. 3-4 (2010): 262–66. http://dx.doi.org/10.2298/mpns1004262p.

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Introduction Congenital fetal anomalies are the great problem and one of the main causes of increased perinatal mortality and morbidity. The aim of this study is to determine the outcome of prenataly detected multicystic dysplastic kidney and to point to the necessity of postnatal diagnostic procedures. Material and methods The retrospective-prospective study encompasses 38 cases of the prenatally diagnosed unilateral fetal multicystic dysplastic kidney. The associated anomalies were revealed either by autopsy findings when the pregnancy was terminated, or when the pregnancy continued, by clinical and operative findings the newborns. Results The autopsy finding revealed bilateral multicystic displastic kidney or unilateral mylticystic displastic kidney and the agenesis of the contralateral kidney. The postnatal evaluation of the newborns with unilateral multicistic disease revealed that 84.3% of them had some concomitant anomaly of the urinary tract, most of them had an anomaly of the contralateral kidney (31.4%). The surgery was performed in 73.6% of children, in 17% of children the kidney function deteriorated after the surgery. Conclusion The findings of bilateral multicystic kidney disease and unilateral multicystic kidney disease and anamnion are the indication to terminate the pregnancy. The finding of an isolated unilateral multicystic dysplastic kidney require thorough examination, both prenatally and postnatally. We propose obligatory serial prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and urinary cystourethography.

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Tamber, Mandeep S., Ann Marie Flannery, Catherine McClung-Smith, Nadege Assassi, David F. Bauer, Alexandra D. Beier, Jeffrey P. Blount, et al. "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants With Myelomeningocele After Prenatal Versus Postnatal Repair." Neurosurgery 85, no. 3 (August 16, 2019): E405—E408. http://dx.doi.org/10.1093/neuros/nyz262.

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Abstract BACKGROUND Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full-text articles were then reviewed, and when appropriate, included as evidence. RESULTS A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.

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Correia, Marta, Fabiana Fortunato, Duarte Martins, Ana Teixeira, Graça Nogueira, Isabel Menezes, and Rui Anjos. "Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal." Acta Médica Portuguesa 28, no. 2 (April 30, 2015): 158. http://dx.doi.org/10.20344/amp.5753.

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Introduction: Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease. Material and Methods:: Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012. Results:: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%)were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality. Discussion:: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease. Conclusion:: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease weren’t diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease.

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Lang, Shih-Shan, Ethan Goldberg, Deborah Zarnow, Mark P. Johnson, Phillip B. Storm, and Gregory G. Heuer. "Prenatal Diagnosis of Hemimegalencephaly." World Neurosurgery 82, no. 1-2 (July 2014): 241.e5–241.e8. http://dx.doi.org/10.1016/j.wneu.2013.09.028.

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Ovaere, Céline, Alex Eggink, Jute Richter, Titia E. Cohen-Overbeek, Frank Van Calenbergh, Katrien Jansen, Dick Oepkes, Roland Devlieger, Luc De Catte, and Jan A. Deprest. "Prenatal Diagnosis and Patient Preferences in Patients with Neural Tube Defects around the Advent of Fetal Surgery in Belgium and Holland." Fetal Diagnosis and Therapy 37, no. 3 (October 3, 2014): 226–34. http://dx.doi.org/10.1159/000365214.

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Introduction: We review the characteristics and prenatal choices of patients recently evaluated for neural tube defects (NTD) at two tertiary units. The prenatal diagnosis of NTD allows parents to consider all prenatal options. In selected cases of spina bifida aperta this also includes fetal surgery, which we started offering after combined ‘in-house' and ‘exported' training. Material and Methods: This is a retrospective review of prospectively collected data on NTD diagnosed over the last 8 years and recent fetal surgery referrals. Results: A total of 167 patients were referred for assessment at a median of 19 weeks. Cranial lesions were diagnosed significantly earlier than spinal lesions. Of the open spinal lesions, 77% were isolated. Of these, 22% were managed expectantly and 1 (1%) had fetal surgery. There was no correlation between parental decisions on prenatal management with disease-specific severity markers. We had 14 fetal surgery referrals, all but 1 from beyond our typical referral area; 6 of the assessed patients were operated on, 4 were expectantly managed and 4 requested termination of pregnancy (TOP). These pregnancy outcomes were in the expected range. Discussion: Open spina bifida is mainly diagnosed in the second trimester and 76% of subjects request TOP, irrespective of the severity indicators. The number of local patients considering fetal surgery is low.

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WOJTYŁKO– GOŁOWKIN, ANNA, MACIEJ BAGŁAJ, and ALEKSANDER WOJTYŁKO. "Prenatal diagnostics of aninborndefects." Medical Science Pulse 8, no. 1 (March 1, 2014): 26–29. http://dx.doi.org/10.5604/01.3001.0003.3157.

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Prenatal diagnosis offers a wide range of tests that can be carried out at various stages of pregnancy in order to conduct early diagnosis of congenital malformations. The purpose of this publication is to discuss the methodology, suitability and availability of prenatal testing. The detection of anatomical abnormalities in utero and postnatal verification of the diagnosis decreases the risk associated with malformation in a significant way. Prenatal detection of the defect requiring the surgical intervention on the first days of the life is particularly important. Intrauterine diagnosing of the defect allows to implement the diagnostic and healing progression at the newborn directly after the birth. Transport in utero is the safest way of transmitting the child to the high- specialistic centre . The consultative team looking after the mother and the newborn with an inborn defect should be composed of specialists from obstetrics, neonatology, pediatrics, anesthesiology, pediatric surgery and genetics. In the case of prenatal suspicion or detection of the defects that are possible to surgically repair, it seems appropriate to incorporate a pediatric surgeon to the therapeutic team in the moment of detection in the prenatal period. According to the Polish Gynecological Association it is recommended for every pregnant woman to have an ultrasound scan of the foetus at least 3 times during pregnancy. Minimally invasive screening is destined to all pregnant women in Poland, irrespective of the age. Invading examinations are proposed in case of the positive screening (presence of genetic sonographic marker or wrong biochemical test results) or for pregnant women with the past medical history and at the age above 35.

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Matthews, Martha S. "Prenatal Pressure Necrosis of the Scalp." Annals of Plastic Surgery 43, no. 1 (July 1999): 74–76. http://dx.doi.org/10.1097/00000637-199907000-00011.

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Steinberg, Jordan P., and Arun K. Gosain. "Thirty Years of Prenatal Cleft Diagnosis." Plastic and Reconstructive Surgery 136, no. 3 (September 2015): 550–57. http://dx.doi.org/10.1097/prs.0000000000001533.

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Albanese, Craig T., and Michael R. Harrison. "Prenatal Cellular Transplantation." Seminars in Pediatric Surgery 8, no. 3 (August 1999): 101–8. http://dx.doi.org/10.1016/s1055-8586(99)70010-7.

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Watanabe, Miho, Aimee G. Kim, and Alan W. Flake. "Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models." Fetal Diagnosis and Therapy 37, no. 3 (July 19, 2014): 197–205. http://dx.doi.org/10.1159/000362931.

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Myelomeningocele (MMC), the most severe form of spina bifida, is a common and devastating malformation. Over two decades of experimental work in animal models have led to the development and clinical application of open fetal surgery for the repair of the MMC defect. This approach offers improved neurofunctional outcomes and is now a clinical option for the management of prenatally diagnosed MMC in selected patients. However, there are still opportunities for further improvement in the prenatal treatment of MMC. A less invasive approach would allow for an application earlier in gestation, with a reduction in maternal and fetal risks and the potential for reduced neurological injury. Tissue engineering offers a realistic and appealing alternative approach for the prenatal treatment of MMC. This review discusses the rationale for tissue engineering in MMC, addresses recent experimental progress and describes potential future directions.

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Cass, Darrell L. "Impact of prenatal diagnosis and therapy on neonatal surgery." Seminars in Fetal and Neonatal Medicine 16, no. 3 (June 2011): 130–38. http://dx.doi.org/10.1016/j.siny.2011.03.007.

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Journal articles on the topic 'Prenatal Surgery'

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