Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.
Objectives The objective of our study was to test the hypothesis that in utero repair of surgically created spina bifida in a sheep model using cryopreserved human umbilical cord (HUC) patch improves neurological outcome.
Methods Spina bifida with myelotomy was surgically created in timed pregnant ewes at gestational day (GD) 75. The fetuses were randomly assigned to unrepaired versus HUC and treated at GD 95 and then delivered at GD 140. Neurological evaluation was performed using the Texas Spinal Cord Injury Scale (TSCIS), bladder control using ultrasound, and the hindbrain herniation.
Results Three lambs without the spina bifida creation served as controls. There were four lambs with spina bifida: two were unrepaired and two underwent HUC repair. The control lambs had normal function. Both unrepaired lambs had nonhealed skin lesions with leakage of cerebrospinal fluid, a 0/20 TSCIS score, no bladder control, and the hindbrain herniation. In contrast, both HUC lambs had a completely healed skin defect and survived to day 2 of life, a 3/20 and 4/20 TSCIS score (nociception), partial bladder control, and normal hindbrain anatomy.
Conclusions Cryopreserved HUC patch appears to improve survival and neurological outcome in this severe form of the ovine model of spina bifida.
Background/Aims: Aortic distension waveforms describe the change in diameter or cross-sectional area over the cardiac cycle. We aimed to validate the association of aortic fractional area change (AFAC) with blood pressure (BP) in a fetal lamb model. Methods: Four pregnant ewes underwent open fetal surgery under general anesthesia at 107-120 gestational days. A 4-Fr catheter was introduced into the fetal femoral artery and vein, or the carotid artery and jugular vein. The thoracic aorta was imaged using real-time ultrasound; AFAC was calculated using offline speckle tracking software. Measurements of invasive BP and AFAC were obtained simultaneously and averaged over 10 cardiac cycles. BP was increased by norepinephrine infusion and the association of aortic distensibility with BP was assessed. Results: Baseline measurements were obtained from 4 lambs, and changes in aortic distensibility with increasing BP were recorded from 3 of them. A positive correlation was found between AFAC and systolic BP (r = 0.692, p = 0.001), diastolic BP (r = 0.647, p = 0.004), mean BP (r = 0.692, p = 0.001), and BP amplitude (r = 0.558, p = 0.016) controlled for heart rate. No association was found between BP and maximum or minimum aortic area. Conclusion: AFAC provides a quantifiable measure of aortic distensibility and correlates with systolic BP, diastolic BP, mean BP, and BP amplitude in a fetal lamb model.
OBJECTIVE: Maternal risks (short and long term) of standard open fetal surgery (OPEN) are significant. While endoscopic human fetal surgery has been in existence for decades, innovation has been slow due to (i) safety concerning use of CO2, (ii) lack of purpose built and suitable instrumentation, and (iii) historically poor maternal/ neonatal outcomes in published series. We investigated intra-and postoperative fetal and maternal outcomes of a new fetoscopic technique using the exteriorized, CO2 filled, human uterus (ENDO) versus the standard OPEN technique. STUDY DESIGN: Retrospective cohort with matched controls-10 ENDO cases (spina bifida (n ¼ 8), amniotic band (n ¼ 1), shunt release (n ¼ 1)) matched (GA at surgery) with 20 OPEN controls (all spina bifida). All surgeries were performed under general anesthesia, and all had the same preoperative and postoperative care protocol. Details of novel aspects of ENDO technique will be provided at time of presentation. Data were compared with parametric and nonparametric tests as appropriate. Significance was set at p < 0.05. RESULTS: Demographic parameters (age, parity, BMI) and gestational age (GA) at surgery (24.8+/-2.7 vs. 24.4+/-1.3 weeks: p ¼ 0.56) were similar in the two groups. GA at delivery trended to later in the ENDO group (Table). 1/7 (14%) ENDO and 6/20 (30%) OPEN delivered < 34 weeks (p ¼ 0.42). ENDO took significantly longer than OPEN (136+/-68 vs. 28+/-9 minutes; p < 0.0001) but blood loss (ml) trended less for ENDO (77+/-40 vs. 120+/-85; p ¼ 0.14). Duration of CO2 exposure was 201 [120-330] minutes. Actual fetal surgery time was longer in ENDO than OPEN cases (135 +/-28 vs. 28 +/-9 minutes; p < 0.001). No abruptions or chorioamnionitis occurred. 0/4 (0%) ENDO vs. 6/20 (30%) OPEN had uterine dehiscence or significant thinning of hysterotomy noted at time of cesarean section (p ¼ 0.21). CONCLUSION: Initial results from a small sample suggest that our ENDO technique does not increase maternal/fetal complications, allows the option of a vaginal delivery, and reduces long-term maternal risks by avoiding a scarred uterus, when compared with OPEN. Short-term outcomes suggest no obvious adverse maternal or fetal effects of CO2 exposure for up to 5.5 hours. This novel ENDO technique may open up new possibilities for the development of in-utero surgery heretofore not considered realistic or feasible.
Only rare cases of anti-Vel-associated mild-to-moderate hemolytic disease of the fetus and newborn have been previously reported. No case of fetal anemia requiring prenatal therapy has been noted to date. We report such a case recently encountered at our Fetal Center. Strategies are discussed for managing pregnancy complicated with alloimmunization to an antibody to a high-prevalence antigen, including sources of red blood cells for intrauterine transfusions. Immunohematology 2017;33:152-154.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.