4. Peri-conceptional folic acid supplementation.
Antenatal steriod to enhance fetal lung
maturity.
Anti D immunoglobulin.
5. Congenital adrenal hyperplasia.
› Dexamethazone 20 ug/kg in three divided doses,
started at 6 W.
› Stopped when proved male fetus or unaffected
female.
6. Fetus with maternal SLE.
Fetus at risk to develop Complete heart
block because of damage to AV bundle.
This can be prevented by giving
Dexamethasone 4 mg per day during
pregnancy.
7. THERAPEUTIC PHARMACOTHERAPY
Cardiac arrhythmias can be managed by
digoxin and/or amiodarone.
Fetal thyroid goitre ….. fetal cord blood for
thyroid status then treated by either
carbimazol or levothyroxin.
8. Termination of pregnancy.
Fetal Image Guided procedures.
Fetal Endoscopic Surgery (FETENDO).
EXIT procedure (Ex-Utero Intrapartum
Treatment Procedure).
Open fetal surgery.
High intensity focused ultrasound (HIFU).
Gene therapy & stem cell.
9. 1961.
› In utero transfusion (liley).
1970s
› Embryoscopy / Fetoscopy was introduced to
visualized malformations.
› High resolution U/S take their diagnostic role.
22. Amniotic Fluid Discordance
Recipient
› Maximum vertical pocket greater than or
equal to 8.0 cm
Donor
› Maximum vertical pocket less than or equal
to 2.0 cm
23. Quintero Staging System
› I. Amniotic Fluid Discordance
› II. Donor Bladder Not Visible
› III. Abnormal Dopplers
› IV. Fetal Hydrops
› V. Fetal Demise
24.
25.
26.
27.
28. Termination of pregnancy.
Fetal Image Guided procedures.
Fetal Endoscopic Surgery (FETENDO).
EXIT procedure (Ex-Utero Intrapartum
Treatment Procedure).
Open fetal surgery.
High intensity focused ultrasound (HIFU).
Gene therapy & stem cell.
29. It is the intervention that occurs at the time of
delivery.
It is primarily used in cases where baby’s
airway requires surgical intervention as:
› CHAOS (Congenital High Airway Obstruction
Syndrome)
› Removal of balloon after treatment of
diaphragmatic hernia.
30.
31. Termination of pregnancy.
Fetal Image Guided procedures.
Fetal Endoscopic Surgery (FETENDO).
EXIT procedure (Ex-Utero Intrapartum
Treatment Procedure).
Open fetal surgery.
High intensity focused ultrasound (HIFU).
Gene therapy & stem cell.
32. Congenital cystic adenomatous
malformation.
› Progressive increase in the size.
› Mediastinal shift.
› Hydrops.
› Polyhydramnios.
Sacrococcygeal teratoma.
› Fetal Hydrops due to vascular shunts. ( high
output heart failure)
Open spina bifida ???
36. Ethical dilemma.
Maternal & Fetal anaesthesia.
Risks both to mother and fetus.
Post surgical tocolysis.
37. Not all procedures are performed regularly.
The results are not guaranteed.
Research in Fetal Surgery is ethically
controversial as it poses a risk to both the fetus
and the mother.
Surgical Animal models do not always replicate
in human beings.
38. Tocolytic therapy can cause pulmonary
edema.
Subsequent delivery by LSCS.
Intraoperative blood loss.
Intra uterine infection.
Deep anaesthesia can cause maternal
myocardial depression.
41. Fetal circulating volume is low, hence little
intra-operative bleeding can cause
hypovolemia.
During prolonged surgery, fetus may be
transfused Oneg blood
Premature closure of Ductus Arteriosus
CNS injuries due to maternal hypoxia or fetal
circulatory disturbance.
42. Assessment of the mother for fitness for
anaesthesia & cross matched blood.
Assessment of the fetus
› Detailed U/S to exclude other malformations.
› O neg blood for fetus kept ready.
› Detailed Fetal Echocardiography.
› Localization of placenta.
› Fetal MRI.
43. Mother given GA with intubation as the
uterus has to be relaxed to allow
manipulation of the uterus.
Intra operative U/S to localise placenta and
to assess the surface anatomy of the fetus
Incision to be taken close to the area of
interest
Uterine Stapler to reduce blood loss
44. The fetus is
monitored with
› Fetal
Echocardiography
› Pulse Oxymetry
Continous Infusion of
warmed Ringer
Lactate to replace
amniotic fluid
45.
46.
47.
48. Termination of pregnancy.
Fetal Image Guided procedures.
Fetal Endoscopic Surgery (FETENDO).
EXIT procedure (Ex-Utero Intrapartum
Treatment Procedure).
Open fetal surgery.
High intensity focused ultrasound (HIFU).
Gene therapy & stem cell.
49. (HIFU) is a non-invasive alternative method
of vessel occlusion which may avoid
complications inherent to surgery.
Still under research in animal study for
treating TTTs, A cardiac twin &
sacrococcygeal teratoma.
Only one case report in human. It was used
to occlude umblical cord vessel in A cardiac
twin (Okai T, et al., 2013)
50. Termination of pregnancy.
Fetal Image Guided procedures.
Fetal Endoscopic Surgery (FETENDO).
EXIT procedure (Ex-Utero Intrapartum
Treatment Procedure).
Open fetal surgery.
High intensity focused ultrasound (HIFU).
Gene therapy & stem cell.
51. It means replacement of missing gene by
introduction of foreign Nucleic acid
sequence.
It is divided into two categories, classic gene
therapy and stem cell gene therapy.
A carrier molecule called a vector (virus-
lentivirus) must be used to deliver the
therapeutic gene to the patient’s target cells.
52. Hematopoeitic stem cells can give rise to
complete blood system.
Potential for treatment or even cure of many
hematopoeitic diseases ( ex. alph thalassemia,
1ry immunodeficiency syndrome).
Theoretically, rejection should not be a problem
of “fetal tolerance”.
Fetus remains in a sterile environment, so post-
transfusion isolation after transplant is
automatic.