Assuntos
Granuloma Piogênico , Procedimentos Cirúrgicos Bucais/métodos , Complicações na Gravidez , Doenças da Língua , Língua/patologia , Adulto , Dissecação , Feminino , Granuloma Piogênico/diagnóstico , Granuloma Piogênico/fisiopatologia , Granuloma Piogênico/cirurgia , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Doenças da Língua/diagnóstico , Doenças da Língua/fisiopatologia , Doenças da Língua/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The evaluation of renal function in fetuses with lower urinary tract obstruction by analysis of electrolytes and beta2-microglobulin in fetal urine has limitations. We measured fetal serum beta2-microglobulin before and after bladder shunting to evaluate renal function. MATERIALS AND METHODS: A total of 12 fetuses with lower urinary tract obstruction underwent vesicoamniotic shunting. In addition to the standard evaluation of urinary electrolytes and beta2-microglobulin, fetal renal status was assessed by pre-shunt and post-shunt fetal serum beta2-microglobulin. RESULTS: At 2 to 4 weeks after shunting 2 of the 12 fetuses had persistent oligohydramnios, demonstrated increased values of serum beta2-microglobulin and were confirmed to have renal dysplasia. In the remaining 10 fetuses there was reaccumulation of amniotic fluid for a minimum of 4 weeks after shunting. Serum beta2-microglobulin values increased after shunting in 4 fetuses, all of which developed renal failure, whereas serum beta2-microglobulin did not change or was decreased after shunting in 6, of which 4 had normal renal function at latest followup. CONCLUSIONS: Urinary electrolytes, urinary beta2-microglobulin and pre-shunt serum beta2-microglobulin, whether increased or normal, failed to be predictive of potential response to prenatal intervention. Serial samples of fetal blood may provide distinction between patients who do and do not respond to prenatal treatment of lower urinary tract obstruction.
Assuntos
Sangue Fetal/química , Diagnóstico Pré-Natal/métodos , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Microglobulina beta-2/análise , Biomarcadores/sangue , Estudos de Coortes , Feminino , Doenças Fetais/sangue , Doenças Fetais/mortalidade , Doenças Fetais/cirurgia , Mortalidade Fetal , Seguimentos , Idade Gestacional , Humanos , Período Pós-Operatório , Gravidez , Resultado da Gravidez , Cuidados Pré-Operatórios , Medição de Risco , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/embriologia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Fetal pleural effusion, a nonspecific accumulation of fluid in the pleural space, is an uncommon anomaly which can be associated with aneuploidy and a range of other structural malformations or genetic syndromes. Spontaneous resolution is not rare and confers a good prognosis. Perinatal outcome is better for those fetuses without hydrops than those presenting with hydrops. A detailed review of the literature indicates that, for fetuses with persistent effusions, in utero intervention (repeated thoracocentesis, intrauterine shunting and pleurodesis) may improve the chances of survival.
Assuntos
Doenças Fetais/diagnóstico , Doenças Fetais/etiologia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Algoritmos , Progressão da Doença , Doenças Fetais/patologia , Fetoscopia/métodos , Humanos , Paracentese , Derrame Pleural/complicações , Derrame Pleural/terapia , Pleurodese/métodos , Cirurgia Torácica Vídeoassistida/métodosRESUMO
Pregnancies complicated by hydramnios are at increased risk of both maternal and fetal complications. Since amniotic pressure is elevated in polyhydramnios, it has been suggested that the complications may be mediated by anomalies connected with amniotic pressure. The rationale behind amnioreduction is thus to restore normal amniotic pressure by draining a large amount of amniotic fluid volume in order to reduce maternal discomfort, improve uteroplacental perfusion, and prolong pregnancy by limiting the risk of preterm labour and rupture of the membranes. The procedure has a complication rate in terms of spontaneous premature rupture of membranes, abruptio placenta, or chorioamnionitis, regardless of the technique adopted.
