scholarly journals Overview of Fetal Therapy

2016 ◽  
Vol 10 (4) ◽  
pp. 387-392
Author(s):  
Tuangsit Wataganara
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Technological Development ◽  
Standard Of Care ◽  
In Utero ◽  
Fetal Therapy ◽  
The Usa ◽  
Potential Benefits ◽  
Prenatal Intervention ◽  
The Right

ABSTRACT An improving ability to diagnose fetal conditions with higher accuracy prompts an attempt for a salvage treatment in utero. Fetal conditions amendable for prenatal intervention are limited to only diseases that can either kill the baby in utero or leave the baby with significant handicap. Therapeutic intervention has to be highly selective. Factors that need to be considered before offering in utero treatment include the highly investigative nature of certain procedures. For instance, at the time of writing this paper, fetal endoluminal tracheal occlusion for severe congenital diaphragmatic hernia is still under a randomized controlled investigational trial to validate its potential benefits and risks to the fetus with severe congenital diaphragmatic hernia with suboptimal growth of the residual lung tissue. There are chances of procedure-related miscarriages, preterm premature rupture of the membranes, and maternal morbidity that need to be discussed in an unbiased counseling session. The right balance between potential benefits and harms requires validation with rigid scientific methodology before the practice has become a “standard of care.” For example, laser photocoagulation of anastomosing chorionic vessels has become a standard of care in many places due to its superior perinatal survival and composite outcomes, particularly for the childhood neurodevelopmental status. With an ongoing technological development, it is foreseeable that there will be more proposals of implementing novel medical technologies to the use of fetal therapy. Currently, there are only a handful of fetal care centers, and most of the experienced ones are clustered in developed part of Europe and the USA. Dissemination of this type of service which requires years of experiences to develop surgical skill and the support by the most technological advanced instrument and setting is a real challenge that need to be addressed, discussed, and solved as a global agenda. How to cite this article Wataganara T, Phithakwatchara N, Nawapun K. Overview of Fetal Therapy. Donald School J Ultrasound Obstet Gynecol 2016;10(4):387-392.

scholarly journals Extracellular Vesicles and Their miRNA Content in Amniotic and Tracheal Fluids of Fetuses with Severe Congenital Diaphragmatic Hernia Undergoing Fetal Intervention

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1493
Author(s):  
Isabella Fabietti ◽  
Tiago Nardi ◽  
Chiara Favero ◽  
Laura Dioni ◽  
Laura Cantone ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Extracellular Vesicles ◽  
Diaphragmatic Hernia ◽  
Target Genes ◽  
In Utero ◽  
Lung Hypoplasia ◽  
Future Research ◽  
Tracheal Occlusion ◽  
Postnatal Mortality ◽  
Prenatal Intervention

Infants with congenital diaphragmatic hernia (CDH) are at high risk of postnatal mortality due to lung hypoplasia and arterial pulmonary hypertension. In severe cases, prenatal intervention by fetal endoscopic tracheal occlusion (FETO) can improve survival by accelerating lung growth. However, postnatal mortality remains in the range of about 50% despite fetal treatment, and there is currently no clear explanation for this different clinical response to FETO. We evaluated the concentration of extracellular vesicles (EVs) and associated microRNA expression in amniotic and tracheal fluids of fetuses with CDH undergoing FETO, and we examined the association between molecular findings and postnatal survival. We observed a higher count of EVs in the amniotic fluid of non-survivors and in the tracheal fluid sampled in utero at the time of reversal of tracheal occlusion, suggesting a pro-inflammatory lung reactivity that is already established in utero and that could be associated with a worse postnatal clinical course. In addition, we observed differential regulation of four EV-enclosed miRNAs (miR-379-5p, miR-889-3p; miR-223-3p; miR-503-5p) in relation to postnatal survival, with target genes possibly involved in altered lung development. Future research should investigate molecular therapeutic agents targeting differentially regulated miRNAs to normalize their expression and potentially improve clinical outcomes.

scholarly journals Prenatal Diagnosis and Management of a Rare Central Tendon Defect Type of Congenital Diaphragmatic Hernia with a Massive Pericardial Effusion

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Inas Babic ◽  
Haifa Al-Jobair ◽  
Osama Al Towaijri ◽  
Huda Al-Shammary ◽  
Merna Atiyah ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Morbidity ◽  
Lung Hypoplasia ◽  
Defect Type ◽  
Tendon Defect ◽  
Prenatal Diagnostic ◽  
Large Pericardial Effusion ◽  
Prenatal Intervention

The central tendon defect type of congenital diaphragmatic hernia (CDH) is extremely rare and usually associated with a significant pericardial effusion. Prenatal diagnostic ultrasound features of this quite rare entity remain often overlooked or misdiagnosed. There is a dearth of literature about the role of prenatal intervention, often through an elective pericardiocentesis, for the prevention of lung hypoplasia and to decrease the overall neonatal morbidity and mortality. To the best of our knowledge, till date, there is only one case that was subjected to a prenatal intervention. Here, we present a second case of a central tendon defect type of CDH with a large pericardial effusion that was subjected to a prenatal transthoracic pericardiocentesis. Although smooth intubation and ventilation were performed immediately after birth, the infant suffered for several months from respiratory instability. Laparoscopic central tendon hernia repair was performed, and neonate was discharged home at seven months of age. Although prenatal pericardiocentesis may facilitate smoother postnatal intubation and ventilation, its broader effect on respiratory function is uncertain and still remains elusive.

Congenital Diaphragmatic Hernia: In Utero Treatment Today and Tomorrow

Fetal Therapy ◽  
2019 ◽  
pp. 503-511
Author(s):  
Jan Deprest ◽  
Anne Debeer ◽  
Lennart Van der Veeken ◽  
Karel Allegaert ◽  
Liesbeth Lewi ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
In Utero

Unilateral pulmonary aplasia and congenital diaphragmatic hernia associated with tetralogy of Fallot: a rare trifecta

2020 ◽  
Vol 30 (1) ◽  
pp. 121-122
Author(s):  
Niraj N. Pandey ◽  
Mumun Sinha ◽  
Sanjeev Kumar
Keyword(s):  
Small Bowel ◽  
Congenital Diaphragmatic Hernia ◽  
Tetralogy Of Fallot ◽  
Diaphragmatic Hernia ◽  
The Right

AbstractWe present a case of a 7-month-old boy with tetralogy of Fallot associated with unilateral pulmonary aplasia and herniation of the liver and small bowel loops in the right hemithorax.

scholarly journals Right Sided Bochdalek Hernia in Adult: A Case Report & Review of Literature

2018 ◽  
Vol 8 (1) ◽  
pp. 44-47
Author(s):  
Bishownath Sharma ◽  
Dipesh Gupta
Keyword(s):  
Case Report ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Bochdalek Hernia ◽  
Review Of Literature ◽  
The Right

Bochdalek hernia is the most common congenital diaphragmatic hernia that typically presents in childhood. However, right sided diaphragmatic hernia is relatively rare. We review the case of 21 years old female with incidentally detected congenital diaphragmatic hernia on the right side. There are fewer than 20 cases of right sided diaphragmatic hernia reported in adults in literature.

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