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Fetal Surgery
This document discusses fetal surgery techniques and criteria. It outlines various prenatal interventions that can be performed including transplacental treatments, needle-based procedures, fetoscopic surgeries, and open repairs. Fetal surgery is performed to treat conditions where prenatal diagnosis is possible, the natural history is known, and there are no effective postnatal treatments. Interventions are done in specialized centers according to strict protocols and ethics approval. Examples of conditions treated include spina bifida, twin-twin transfusion syndrome (TTTS), and lower urinary tract obstruction (LUTO). The document presents data from trials demonstrating improved outcomes for fetal surgery compared to postnatal care for conditions like myelomeningocele (MMC).
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Fetal Surgery
- 1. Fetal Surgery 2016 InnovationSummit David Lynch-Salamon, MD Medical Director Midwest Fetal Care Center
- 2. • 1. Accuratediagnosis and staging possible, with exclusion of associated anomalies. • 2. Natural history of the disease is documented, and prognosis is established. • 3. Currently no effective postnatal therapy. • 4. In utero surgery proven feasible in animal models, reversing deleterious effects of the condition. • 5. Interventions performed in specialized multidisciplinary fetal treatment centers within strict protocols and approval of the local Ethics Committee with informed consent of the mother or parents. Criteria for Fetal Surgery Harrison et al, NEJM, 1982
- 3. Fetal Therapy • Transplacental •Needle based • Fetoscopic • Open
- 4. • Betamethasone • Antiarrhythmicdrugs • Thyroid medication Transplacental
- 5. • Cordocentesis fortransfusion or medication administration • Shunt placement • Ablation of vascular connections Needle Based
- 6. • Disorders ofmonochorionic placentation − TTTS − TAPS − sIUGR − TRAP • Amniotic band sequence • FETO • Spina bifida repair • Lower urinary tract obstruction (LUTO) Fetoscopic
- 7. • Spina bifida •LUTO • Congenital pulmonary airway malformations (CPAM) • Sacrococcygeal teratoma • Other masses Open Repairs
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- 9. • Prospective andrandomized • Prenatl vs postnatal repair • NEJM 2011 • Less need for VP shunt in first year (44% vs 84%) • Improved mental/motor composite score at 30 months • Less need for intermittent catheterization (38% vs 51%) • Durable MOMS Trial
- 11. • Prospective andrandomized • Laser vs amnioreduction • Stopped early due to significant benefit in laser group • NEJM 2004 • Better survival of at least one twin at 28 days (76% vs 56%) • More likely to be free of neurologic complications (52% vs 31%) Laser for TTTS
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- 13. Sagittal US at25 3/7 weeks
- 14. Head US at25 3/7 weeks
- 15. US Guided Decompressionof the Distal Trachea
- 16. US Guided Decompressionof the Distal Trachea
- 17. US Guided Decompressionof the Distal Trachea
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- 19. Head US at29 Weeks
- 20. 2015 2016 YTD PedsCards Echos 747 672 Laser 15 20 Bladder Shunt 2 Patients 4 Procedures 2 Patients 4 Procedures PUBS 4 Patients 6 Procedures 2 Patients 8 Procedures Complicated Mono 1 2 Thoracentesis 0 2 Tracheocentesis 0 1 MMC 0 3 MWFCC Procedures