l " gestational trophoblastic disease l " hydatidiform moles l " molar pregnancy l " gestational neoplasia l " human chorion gonadotropin Schlüsselwörter l " gestationsbedingte Trophoblasterkrankung l " Blasenmole l " molare Schwangerschaft l " gestationsbedingte Neoplasie l " humanes Choriongonadotropin
Objective: The current operative approach for fetal repair of spina bifida aperta requires maternal laparotomy and hysterotomy. Following technical feasibility studies in sheep, we performed percutaneous fetoscopic patch coverage of this lesion in 3 human fetuses between 23 + 4 and 25 + 3 weeks of gestation. Methods and Results: Whereas the patch detached in the first case 3 weeks after the procedure, it covered the exposed neural tissue in the 2 other fetuses beyond their delivery. Two of the three children survived, but 1 unexpectedly died from a ventilation problem in its 3rd week of life. In 1 of the 2 survivors, ventriculoperitoneal shunt insertion was delayed. Conclusions: Percutaneous fetoscopic patch coverage of spina bifida aperta is feasible in human fetuses and offers a substantial reduction of maternal trauma compared to open fetal repair. Further clinical experience is now required before the efficacy of the new approach to protect the exposed neural tissue from mechanical and chemical damage and to improve hindbrain herniation can be evaluated.
Postpartum depression (PPD) is the most common mental illness in mothers following the birth of a child. Since the symptoms of PPD are similar to the normal stress of healthy women following childbirth, it is often difficult for the attending gynaecologist or midwife to diagnose this illness in a timely manner and thus initiate adequate treatment and comprehensive support for the patient. Even if there are options for a screening using evaluated questionnaires and subsequent psychotherapy and/or drug therapy in the treatment of PPD which has proven effective, it is seen that, in most treatment approaches, little consideration is given to the affect-controlled interaction and the bonding behaviour between mother and child. This article presents diagnostic measures and current therapeutic approaches as well as their integration in practice in order to achieve awareness of this topic in everyday clinical practice and show the pathways of appropriate treatment. Specific multiprofessional treatment approaches which centre on the mother-child relationship demonstrate successes with regard to depression in the mothers and also on the development of a secure mother-child bond and are thus a protective factor in the development of the affected children. The now well-known effects of PPD on the fathers as well as the negative impacts of paternal depression on child development make it clear that the treatment should not focus solely on maternal depression, but also always on the family bond between the mother, child and father in the treatment.
Fetuses with isolated gastroschisis successfully underwent postnatal surgery in most cases (93.2 %), except for one termination, one intrauterine death and 3 cases of neonatal death. A fetal bowel dilatation > 10 mm before 30 + 0 weeks had the highest predictive value for postnatal bowel complications.
A 23-year-old primigravida was referred to our institute at 12 + 4 weeks' gestation with increased nuchal translucency (NT) thickness. Family history and the pregnancy to date were normal. On ultrasound examination using a Voluson E8 (GE Medical Systems, Zipf, Austria) equipped with a 3.5-5-MHz transabdominal probe, the crown-rump length was 71.3 mm and NT measured 2.5 mm. Echocardiography revealed both tricuspid valve and mitral valve insufficiency. A positive A-wave was observed in the ductus venosus on Doppler imaging. Neither pleural effusion nor ascites was found. Suspecting fetal anemia, we arranged for a serological examination of maternal blood which showed acute parvovirus infection (parvovirus B19 immunoglobulin (IgG) positive; IgG, 20 IU/mL; parvovirus B19 IgM positive; IgM index, 9.6).At 12 + 6 weeks' gestation there were signs of significant deterioration in the fetal condition with reversed flow in the ductus venosus during atrial contraction, the development of fetal hydrops and persistent atrioventricular (AV) valve insufficiency. At 13 + 0 weeks' gestation the fetus received an intracardiac transfusion of 1.5 mL irradiated red blood cell concentrate with increased hematocrit (blood group O rhesus negative) plus 0.5 mL of a platelet concentrate given through a 22-G needle.Three days after transfusion, positive flow in the A-wave of the ductus venosus was noted and the AV valve insufficiency showed signs of improvement. Generalized hydrops was no longer evident. The NT had increased to 4.4 mm. A second transfusion of 2 mL red blood cell concentrate and 1 mL platelet concentrate was given through the umbilical vein at the placental insertion. Blood sampling for red blood cell count proved impossible as the vein collapsed on aspiration.At 13 + 5 weeks' gestation, signs of deterioration (reversal of flow in the ductus venosus and an increase in NT to 5.6 mm) suggested a progression of fetal anemia. We therefore gave 2.5 mL red blood cells intravenously. Improvement was evident in both AV valves and in the ductus venosus waveform.There was renewed deterioration of flow in the ductus venosus at 14 + 4 weeks' gestation and fetal middle cerebral artery velocity was high at 35.0 cm/s 1 . Repeat transfusion was performed intravascularly with 2.5 mL red blood cell concentrate. NT thickness remained at 5.6 mm, and only the tricuspid valve still showed signs of insufficiency.At 15 + 6 weeks' gestation fetal middle cerebral artery velocity had increased to 39.5 cm/s. A fifth intravascular transfusion of 2.9 mL red blood cell concentrate was performed and the subsequent hemoglobin level was 12.0 g/dL.Follow-up ultrasound examinations showed normal fetal development. A small echogenic focus in the myocardium of the right ventricle that had been noted at the time of the first intracardiac transfusion persisted until birth. A small pericardial effusion documented after the first blood transfusion resolved completely by 17 weeks' gestation. Fetal magnetic resonance imaging at 28 + 5 weeks' gestation showed no evide...
Percutaneous fetoscopic balloon occlusion of the fetal trachea can effectively and safely be achieved in sheep. Because intraamniotic spatial relationships, fetal position, and umbilical cord length are technically less favorable in sheep, our operative techniques might be feasible in humans even if difficult intraamniotic conditions are encountered.
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