Hypothetical role of prostaglandins in the onset of preterm labor after fetal surgery
ABSTRACT Preterm labor is one of the most important factors limiting the advancement of fetal surgery programs. While prostaglandins (PGs) have long been indicated as the key factor in the initiation of labor in humans, there is significant evidence showing that the chorionic membrane acts as a powerful barrier between the decidua/myometrium and amniotic PGs during normal pregnancy. After either open or endoscopic fetal surgery the imperfect, non-hermetical closure of the chorion permits leakage of PGs from the amnionic sac, allowing them to reach the decidua and myometrium. The surgical wound in the chorionic barrier could be the major factor involved in preterm labor and delivery after human fetal surgery.
SourceAvailable from: Jacek Zamłyński[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: The aim of the study was a randomized comparison of the outcomes of intrauterine myelomeningocele repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. Methods: The study group (SG) comprised of 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. Results: High incidence of PROM (24 (52.2%), CI 3.74 (1.69-8.26) (p<0.001) was noted in the group of prenatal surgeries as compared to controls. The need for VP shunt implantation was statistically significantly lower (p<0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the study group (2 (11.1%) CI 1.86 (1.00-3.48) p<0.048) are able to walk independently. Conclusions: Prenatal MMC closure significantly lowers further adverse evolution of the type II Chiari malformation. Further studies are needed, especially on preventive measures for preterm labor and IPPROM in the postoperative course of IUMR.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2013; 27(14). DOI:10.3109/14767058.2013.858689 · 1.21 Impact Factor
Circulation 03/2010; 121(10):1256-63. DOI:10.1161/CIRCULATIONAHA.109.870246 · 14.95 Impact Factor
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ABSTRACT: Fetal cardiac interventions performed by interventional cardiologists are currently in a clinical experimental phase. The 3 most frequent interventions are: 1) aortic balloon valvuloplasty for critical aortic stenosis with a small left ventricle or with a normal size left ventricle but poor function; 2) atrial septostomy for highly restrictive or intact atrial septum in hypoplastic left heart syndrome; and 3) pulmonary valvuloplasty for pulmonary atresia and hypoplastic right ventricle. Current impact on everyday congenital heart surgery practice is small, but may increase in the future.Pediatric Cardiac Surgery Annual of the Seminars in Thoracic and Cardiovascular Surgery 01/2011; 14(1):35-7. DOI:10.1053/j.pcsu.2011.01.003