| Popis: |
repair of fetal MMC using a modified surgical technique without the use of a trocar from February through July 2011 are presented. Uterine entry and closure were modified to minimize trauma to the amniotic membrane and chorioamnion separation. Patients were admitted for five days, then discharged home for continued care by their referring maternal-fetal medicine specialist. Weekly ultrasound reports were obtained from primary MFM providers and reviewed for chorioamnion separation, amniotic fluid index (AFI), ventriculomegaly and fetal well-being. Delivery data were obtained from the delivering physicians. RESULTS: Of the 13 patients included in this series, there have been no cases of chorioamnion separation to date. Seven patients delivered between 34 to 37 weeks’ gestation. Of these, three patients were delivered electively at 34 weeks’ gestation: one patient for oligohydramnios, one patient experienced premature rupture of membranes (PROM) at 31 weeks’ gestation and was managed expectantly, and one patient was delivered for increasing ventriculomegaly. Five patients are currently undelivered, between 30 to 34 weeks’ gestation, with normal AFI. The thirteenth patient is at 28 weeks’ gestation with normal AFI at the time of this submission. There were no instances of uterine dehisence or wall thinning in the patients delivered. No patient received a blood transfusion. CONCLUSION: Early results suggest that a modified surgical approach to uterine entry, amniotic membrane handling and uterine closure may result in a decreased risk of chorioamnion separation and PROM. Further assessment of results with this technique in a growing series is ongoing. |
Full Text from ScienceDirect