State of the Art in Fetal Surgery: Past, Present and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 29 July 2024 | Viewed by 810

Special Issue Editors


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Guest Editor
Department of Obstetrics & Gynecology, Istituto di Ricerca a Carattere Clinico-Scientifico, AUSL di Reggio Emilia, Italy
Interests: prenatal diagnosis; ultrasound; high-risk pregnancy; intrapartum fetal asphyxia; perinatal outcome
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Guest Editor
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
Interests: congenital diaphragm hernia; fetal bladder obstruction; fetal spina bifida; twin-twin transfusion syndrome; fetal cystoscopy; prenatal imaging

Special Issue Information

Dear Colleagues,

It is with great pleasure that we are launching a Special Issue on “The State of the Art of Fetal Surgery: Past, Present and Future Perspectives”. The focus of this Special Issue is on compiling the ultimate scientific evidence on indications, complications, and outcomes of the main fetal surgeries for congenital conditions.

Fetal surgery is a complex intervention to treat a variety of life-threatening anomalies in babies before they are born. Recently, with the development of genetic diagnosis and imaging technology, we have a better understanding of fetal development, and the field of fetal surgery has evolved significantly.

Currently, the following conditions for fetal surgery can be accepted: twin–twin transfusion syndrome (TTTS); myelomeningocele/open spina bifida; severe, isolated, left congenital diaphragmatic hernia (CDH); neck masses occluding the upper airways; lower urinary tract obstruction (LUTO); and so on. However, the limited physical fetal access and technological aspects, and the problems linked to identifying ideal fetal candidates and optimal timing for antenatal intervention lead to risks such as premature, preterm rupture of membrane (pPROM) and preterm labor, iatrogenic rupture of the uterus after surgery, intrauterine fetal demise (IUFD), intra- and post-operative complications, and potential failure to treat birth defects. The technological advancements of three-dimensional ultrasound and fetal magnetic resonance imaging (MRI) play a central, clinical role in assisting in and planning the timing of surgical intervention. Futuristic imaging such as 3D physical models of congenital anomalies and the most recent the use of physician avatars using metaverse have further supported the modern antenatal diagnostic armamentarium towards generating an immersive reality. The use of digital reality may enhance the bonding of the parents-to-be with the type of fetal malformation and ameliorate the understanding of the genetic counseling and surgical planning. Furthermore, modern fetal surgeons have received new training tools that will be of paramount value in academic training settings and in preparing the procedures.

This Special Issue aims to collect original research papers and review articles which discuss the current state of the art, address existing knowledge gaps, and focus on the innovation of fetal surgery.

Prof. Dr. Gabriele Tonni
Prof. Dr. Rodrigo Ruano
Guest Editors

Manuscript Submission Information

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Keywords

  • fetal surgery
  • early intervention
  • minimally invasive surgery
  • perinatal outcome
  • three-dimensional ultrasound
  • virtual reality

Published Papers (1 paper)

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Research

14 pages, 262 KiB  
Article
Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil
by David Baptista da Silva Pares, Gilda Helena Arruda Sousa Pacheco, Guilherme Antonio Rago Lobo and Edward Araujo Júnior
J. Clin. Med. 2024, 13(5), 1362; https://doi.org/10.3390/jcm13051362 - 28 Feb 2024
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Abstract
Objective: This study aimed to describe the historical experience of a single reference center in Brazil with intrauterine transfusion (IUT) for Rhesus (Rh) alloimmunization, evaluating the major complications and the perinatal outcomes of this procedure. Methods: This retrospective cohort study evaluated data from [...] Read more.
Objective: This study aimed to describe the historical experience of a single reference center in Brazil with intrauterine transfusion (IUT) for Rhesus (Rh) alloimmunization, evaluating the major complications and the perinatal outcomes of this procedure. Methods: This retrospective cohort study evaluated data from medical records of pregnant women between 20 and 34 weeks of gestation whose fetuses underwent IUT by cordocentesis between January 1991 and June 2021. The same experienced examiner performed all procedures. Univariate and multivariate logistic regression was used to assess the effect of fetal hydrops, duration of IUT, post-transfusion cord bleeding time, and bradycardia on death (fetal or neonatal). Results: We analyzed data from 388 IUTs in 169 fetuses of alloimmunized pregnant women with a mean age of 29.3 ± 5.1 years. Death and fetal hydrops were significantly associated at first IUT (p < 0.001). We had two cases of emergency cesarean section (mean of 0.51% per IUT) and three cases of premature rupture of the ovular membranes (mean of 0.77% per procedure). Thirty-six deaths were recorded, including 14 intrauterine and 22 neonatal. A higher percentage of neonatal deaths was observed in the group with post-transfusion cord bleeding time > 120 s (45.8%). The odds of neonatal death were 17.6 and 12.9 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. The odds of death (fetal and neonatal) were 79.9 and 92.3 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. Conclusions: The most common complications of IUT for Rh alloimmunization were post-transfusion cord bleeding, fetal bradycardia, premature rupture of ovular membranes, and emergency cesarean section. The IUT complication most associated with death (fetal and neonatal) was bradycardia, and the perinatal outcomes were worse in fetuses with hydrops. Full article
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