Prenatal Counseling for Maternal–Fetal Surgery

Author(s):  
Stephen D. Brown

This chapter analyzes potential biases and competing interests in prenatal counseling when conditions are diagnosed for which intrauterine surgery may be possible. Such counseling often occurs at the multidimensional interface of obstetrics and pediatrics. After considering clinical, social, and historical contexts of such counseling, the chapter presents a case that illustrates how physician demographics, interspecialty differences, divergent clinical experiences, and larger organizational factors may compound practice variation. It considers how biased counseling may influence patients’ decisions and questions whether value-neutral counseling is attainable when such fetal conditions are diagnosed. It concludes that declared commitments to value neutrality cannot insulate pregnant patients from biases and competing interests. In its recommendations, it discusses organizational responses analogous to conflict-of-interest policies. It further suggests that conversations between clinicians and patients that are mutually open about values may enhance rather than undermine patients’ ability to formulate decisions that most closely embody their true preferences.

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Herman Aksom

PurposeInstitutional theory had been developed for the purpose of explaining widespread diffusion, mimetic adoption and institutionalization of organizational practices. However, further extensions of institutional theory are needed to explain a range of different institutional trajectories and organizational responses since institutionalized standards constitute a minority of all diffusing practices. The study presents a theoretical framework which offers guidelines for explaining and predicting various adoption, variation and post-adoption scenarios.Design/methodology/approachThe paper is primarily conceptual in nature, and the arguments are developed based on previous institutional theory and organizational change literature.FindingsThe notion of institutional inertia is proposed in order to provide a more detailed explanation of when and why organizations ignore, adopt, modify, maintain and abandon practices and the way intra-organizational institutional pressures shape, direct and constrain these processes. It is specified whether institutional inertia will be temporarily eclipsed or whether it will actively manifest itself during adoption, adaptation and maintaining attempts. The study distinguishes between four institutional profiles of organizational practices – institutionalized, institutionally friendly, neutral and contested practices – which can vary along three dimensions: accuracy, extensiveness and meaning. The variation and post-adoption outcomes for each of them can be completely characterized and predicted by only three parameters: the rate of institutional inertia, institutional profile of these practices and whether they are interpretatively flexible. In turn, an extent of intraorganizational institutional resistance to new practices is determined by their institutional profile and flexibility.Practical implicationsIt is expected that proposed theoretical explanations in this paper can offer insights into these empirical puzzles and supply a broader view of organizational and management changes. The study’s theoretical propositions help to understand what happens to organizational practices after they are handled by organizations, thus moving beyond the adoption/rejection dichotomy.Originality/valueThe paper explores and clarifies the nature of institutional inertia and offers an explanation of its manifestation in organizations over time and how it shapes organizational practices in the short and long run. It challenges a popular assumption in organizational literature that fast and revolutionary transition is a prerequisite for successful change. More broadly, the typology offered in this paper helps to explain whether and how organizations can successfully handle and complete their change and how far they can depart from institutional norms.


2020 ◽  
Vol 25 (6) ◽  
pp. 640-647
Author(s):  
Vijay M. Ravindra ◽  
Guillermo Aldave ◽  
Howard L. Weiner ◽  
Timothy Lee ◽  
Michael A. Belfort ◽  
...  

OBJECTIVEThe Management of Myelomeningocele Study demonstrated that fetal surgery, as compared to postnatal repair, decreases the rate of hydrocephalus and improves expected motor function. However, fetal surgery is associated with significant maternal and neonatal risks including uterine wall dehiscence, prematurity, and fetal or neonatal death. The goal of this study was to provide information about counseling expectant mothers regarding myelomeningocele in the era of fetal surgery.METHODSThe authors conducted an extensive review of topics pertinent to counseling in the setting of myelomeningocele and introduce a new model for shared decision-making to aid practitioners during counseling.RESULTSExpectant mothers must decide in a timely manner among several potential options, namely termination of pregnancy, postnatal surgery, or fetal surgery. Multiple factors influence the decision, including maternal health, fetal heath, financial resources, social support, risk aversion, access to care, family planning, and values. In many cases, it is a difficult decision that benefits from the guidance of a pediatric neurosurgeon.CONCLUSIONSThe authors review critical issues of prenatal counseling for myelomeningocele and discuss the process of shared decision-making as a framework to aid expectant mothers in choosing the treatment option best for them.


1995 ◽  
Vol 32 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Kerby C. Oberg ◽  
Michele L. Evans ◽  
Thanh Nguyen ◽  
Norman H. Peckham ◽  
Wolff M. Kirsch ◽  
...  

We compared the difference between a nonpenetrating silver microclip and suture on wound healing, inflammatory response, and application time in the repair of surgically created standardized unilateral cleft lip type defects in fetal mice. Excellent lip continuity and dermal reconstitution were achieved by both methods of repair. Furthermore, collagen accumulation did not occur. Occasional mononuclear cells were seen around sutured repairs in contrast to microclipped repairs. The most significant difference, however, was in application time with the microclip requiring an average of 7 seconds (±2) compared to 90 seconds (±15) for suture. We conclude that the microclip offers distinct advantages for Intrauterine cleft lip repair: (1) nonpenetrating tissue approximation; (2) less inflammatory response than suture; (3) technically more rapid and less difficult to apply than suture; and (4) can be utilized more readily than suture for endoscopic approaches limiting the risks of fetal surgery for both the mother and the fetus.


Author(s):  
Renato AM de Sá ◽  
Fernando Peixoto-Filho ◽  
Luciana Cima

ABSTRACT Ultrasound imaging has led to the diagnosis of fetal anomalies that can affect many organ systems. Since the development of high-resolution real-time ultrasound, the possibility of surgical intervention before birth to correct or treat prenatally diagnosed abnormalities has been realized. Fetal surgery has become a new standard of care for the perinatal treatment of myelomeningocele for mothers and fetuses that meet the specific criteria. In this review, we will consider the role of ultrasound for open fetal surgery or minimally invasive fetal surgery approaches. How to cite this article Moreira de Sá RA, Peixoto-Filho F, Cima L. Intrauterine Surgery for Spinal Defects: What is the Role of Ultrasound? Donald School J Ultrasound Obstet Gynecol 2016;10(3):297-300.


2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Renato Augusto Moreira de Sá ◽  
Paulo Roberto Nassar de Carvalho ◽  
Asim Kurjak ◽  
Abdallah Adra ◽  
Aliyu Labaran Dayyabu ◽  
...  

AbstractFetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.


2019 ◽  
pp. e710
Author(s):  
Marcelo José da Silva de Magalhães ◽  
Brunno Pedreira Montenegro Pimenta ◽  
Heitor Oliveira Gomes ◽  
José Valci Fernandes Neto ◽  
Rônney Vasconcelos de Oliveira ◽  
...  

Objetivo: Descrever as alterações neuroanatômicas do SNC encontradas nos exames de neuroimagem nos pacientes com malformação de Chiari II. Métodos: Trata-se de uma revisão descritiva baseada em artigos provenientes da base de dados BVS, Scielo e PubMed. Foram utilizados artigos compreendidos em um período de 21 anos (entre 1997 e 2016). Os descritores utilizados foram “Chiari II”, “fetal surgery”, “hydrocephalus”, “intrauterine surgery”, “myelomeningocele”, “prenatal”, “symptomatic Chiari II”, “spina bifida” e “spinal dysraphisms”. Resultados: As malformações de Chiari II encontram-se inseridas no espectro de anormalidades congênitas do sistema nervoso central (SNC). É caracterizada por uma deformidade complexa da fossa posterior associada quase sempre a uma malformação da coluna vertebral. As alterações encefálicas mais sugestivas dessa patologia são anormalidades cerebelares; deslocamento caudal da ponte, IV ventrículo e bulbo; torção medular; IV ventrículo em formato anormal e hipoplasia da tenda do cerebelo e do teto do mesencéfalo. O diagnóstico pode ser realizado através da ultrassonografia, tomografia computadorizada e ressonância magnética. Considerações finais: A Malformação de Chiari II é uma doença que apresenta quadro clínico e alterações radiológicas complexas e extensas. Mais estudos que considerem as alterações morfológicas são necessários.


1995 ◽  
Vol 4 (2) ◽  
pp. 31-36 ◽  
Author(s):  
Joanne E. Roberts ◽  
Elizabeth Crais ◽  
Thomas Layton ◽  
Linda Watson ◽  
Debbie Reinhartsen

This article describes an early intervention program designed for speech-language pathologists enrolled in a master's-level program. The program provided students with courses and clinical experiences that prepared them to work with birth to 5-year-old children and their families in a family-centered, interdisciplinary, and ecologically valid manner. The effectiveness of the program was documented by pre- and post-training measures and supported the feasibility of instituting an early childhood specialization within a traditional graduate program in speech-language pathology.


2020 ◽  
Vol 29 (2) ◽  
pp. 841-850 ◽  
Author(s):  
Courtney T. Byrd ◽  
Danielle Werle ◽  
Kenneth O. St. Louis

Purpose Speech-language pathologists (SLPs) anecdotally report concern that their interactions with a child who stutters, including even the use of the term “stuttering,” might contribute to negative affective, behavioral, and cognitive consequences. This study investigated SLPs' comfort in providing a diagnosis of “stuttering” to children's parents/caregivers, as compared to other commonly diagnosed developmental communication disorders. Method One hundred forty-one school-based SLPs participated in this study. Participants were randomly assigned to one of two vignettes detailing an evaluation feedback session. Then, participants rated their level of comfort disclosing diagnostic terms to parents/caregivers. Participants provided rationale for their ratings and answered various questions regarding academic and clinical experiences to identify factors that may have influenced ratings. Results SLPs were significantly less likely to feel comfortable using the term “stuttering” compared to other communication disorders. Thematic responses revealed increased experience with a specific speech-language population was related to higher comfort levels with using its diagnostic term. Additionally, knowing a person who stutters predicted greater comfort levels as compared to other clinical and academic experiences. Conclusions SLPs were significantly less comfortable relaying the diagnosis “stuttering” to families compared to other speech-language diagnoses. Given the potential deleterious effects of avoidance of this term for both parents and children who stutter, future research should explore whether increased exposure to persons who stutter of all ages systematically improves comfort level with the use of this term.


1975 ◽  
Vol 40 (1) ◽  
pp. 92-105 ◽  
Author(s):  
Lawrence D. Shriberg

A response evocation program, some principles underlying its development and administration, and a review of some clinical experiences with the program are presented. Sixty-five children with developmental articulation errors of the /ɝ/ phoneme were administered the program by one of 19 clinicians. Approximately 70% of program administrations resulted in a child emitting a good /ɝ/ within six minutes. Approximately 10% of children who were given additional training on program step failures emitted good /ɝ/'s in subsequent sessions. These preliminary observations are discussed in relation to the role of task analysis and motor skills learning principles in response evocation, clinician influences in program outcomes, and professional issues in service delivery to children with developmental articulation errors.


2011 ◽  
Vol 12 (4) ◽  
pp. 121-127 ◽  
Author(s):  
Elizabeth Lanter ◽  
Claire Waldron

Abstract The authors describe an innovative clinical education program that emphasizes the provision of written language services by preservice speech-language pathology graduate students at Radford University in Virginia. Clinicians combined academic coursework in language acquisition in school-age children and clinical experiences that target children's written language development to promote future literacy-based leadership roles and collaborative efforts among school-based speech-language pathologists (SLPs). These literacy-based experiences prepare SLPs to serve in the growing numbers of American public schools that are implementing Response to Intervention models.


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