[FULL] Obstetricia Y Medicina Materno Fetal 23 Free ☘️
[FULL] Obstetricia Y Medicina Materno Fetal 23
all cardiac procedures in the fetus should follow a patient-centered approach that involves careful assessment of all pregnant patients with chd as to their desire for intervention in order to plan for the immediate delivery of the fetus as well as to preterm delivery for delivery of the infant in order to facilitate optimal management of the infant. the availability of the mother for transfer to the operating room immediately after the decision for planned delivery is a key factor in managing a planned delivery. the decision for intervention is also influenced by the severity of the fetal anomaly and complexity of the fetal cardiac defect. maternal and fetal monitoring and anesthetic considerations, including fetal well-being, and characteristics of the medical equipment must be assessed before intervention, and this should be performed by a multidisciplinary team of obstetric and pediatric cardiac care providers. the approach to the delivery of the infant is affected by the extent and severity of the congenital cardiac defect, the anatomy of the heart (right-sided versus left-sided versus single ventricle), the gestational age at surgery, the availability and type of cardiac equipment, the characteristics of the surgical team, maternal characteristics, and preparation for transfer of the patient to the operating room. if a fetus is born at the appropriate gestational age, immediate transfer of the fetus to the neonatal intensive care unit should be performed with consideration of the mother’s condition, and anesthesia and stabilization before surgical intervention should be performed. if a planned delivery is not performed, the mother and fetus must be monitored and monitored closely for the postnatal course.
despite recent advances in the antenatal diagnosis of chd in the fetus and early postnatal management of prenatally diagnosed chd, there remain significant challenges related to the early recognition and successful treatment of fetal tachyarrhythmias, particularly in the setting of chronic hydrops. a number of case reports illustrate the successful treatment of these supraventricular tachyarrhythmias with transplacental therapy, including maternal-fetal digoxin administration, which has been noted to not affect fetal qtc duration, as well as fetal oral sotalol and maternal oral digoxin. 456, 473 transplacental therapy in fetuses that are hydropic and have received icd therapy for recurrent tachyarrhythmias also is being increasingly reported, along with decreasing icd shocks to treat these supraventricular tachyarrhythmias. thus, fetal tachyarrhythmias secondary to hydrops that respond to oral therapy are being increasingly treated with oral therapy, rather than icd therapy. fetal responses to intrauterine treatment for chd can be long-lasting, and studies are needed to further evaluate the safety and effectiveness of transplacental therapy.
small single-arm trials have demonstrated the feasibility, safety, and benefit of fetal interventions such as umbilical cord occlusion (in the setting of vascular malformations) and cord avulsions for preservation of well-being in the fetus, potentially improving chances of survival when considering delivery at another institution or delivery at home. 155, 156 ongoing multicenter fetal therapy trials are using these techniques to better define both their safety and efficacy.