Denise Araújo Lapa

Hospital Infantil Sabara · Fetal Therapy Group

Background: Myelomeningocele (MMC) causes significant morbidity and mortality. Efforts have been directed to correct this defect in utero. The neuropathology literature on antenatally repaired MMC and associated complications in humans is limited. Case report: A 12-day-old female, who underwent prenatal MMC repair via a two-layer closure (dural rep...

(Am J Obstet Gynecol. 2021;225:678.e1–678.e11. [Epub June 3, 2021]) Prenatal repair of open spina bifida (OSB) showed increased chance of independent ambulation and increased outcomes of ventriculoperitoneal shunting compared with postnatal repair in a multicenter randomized controlled trial in the Management of Myelomeningocele Study (MOMS). The t...

Objective: To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods: Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic's medical recor...

Objective This study aims to develop a preoperative planning method using augmented reality (AR) of a specific surgical procedure: fetoscopy for myelomeningocele repair. Methods Imaging data were acquired of a pregnant woman at 27 weeks of gestation whose fetus was diagnosed with myelomeningocele. As candidate to fetoscopic repair of the spine def...

Objectives: To determine the prevalence of brain anomalies in fetuses eligible for prenatal open spina bifida (OSB) repair at the time of preoperative assessment, and to explore the relationship with the features of spinal defect. Methods: Retrospective cross-sectional multicentric study in fetal medicine centers on fetuses undergoing OSB fetal...

Background The multicenter randomized control trial Management of Myelomeningocele Study (MOMS) demonstrated that prenatal repair of open spina bifida (OSB) via hysterotomy, compared with postnatal repair, decreases the need for ventriculoperitoneal shunting and increases the chances of independent ambulation. However, the hysterotomy approach is a...

Skin-over-biocellulose for Antenatal Fetoscopic Repair (SAFER) is a recently developed technique for fully percutaneous fetoscopic repair of myelomeningocele. The formation of a neo-dura mater triggered by the use of a biocellulose patch over the placode obviates the need of primary repair of fetal dura mater, and seems to further improve neurodeve...

Background: A trial comparing prenatal with postnatal open spina bifida (OSB) repair established that prenatal surgery was associated with better postnatal outcome. However, in the trial the fetal surgery was carried out through hysterotomy. Minimally invasive approaches are being developed to mitigate the risks of open maternal fetal surgery. Ob...

Background Congenital high airway obstruction syndrome (CHAOS) involves the partial or complete obstruction of the fetal upper airways, usually caused by atresia or stenosis of the larynx or trachea. The obstruction of bronchial tree leads to lung distension, diaphragmatic eversion, and cardiac dysfunction, which can result in fetal death. Case A...

We present a case-based review of the first five percutaneous fetoscopic in-utero spina bifida repair procedures undertaken in the UK. Our focus is on implications of anaesthesia and analgesia for the mother and fetus, provision of uterine relaxation and fetal immobilisation while providing conditions conducive to surgical access. Minimizing risks...

Objective: Recent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors' aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalu...

Objectives: The Management Of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida (SB). Recently developed alternative techniques may reduce maternal risks yet should do without compromising on fetal neuroprotective effects. We aimed to assess the learning curve of different fetal SB clos...

Objective: To describe our initial experience with a novel approach to follow-up and treat gastroschisis in "zero minute" using the EXITlike procedure. Methods: Eleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as histori...

Table S1 Review of surgical techniques and patches, aiming to correct a meningomyelocele‐like defect in fetal sheep, published between 1993 and 2009 (adapted from Abou‐Jamra et al. 22, with permission).

Since the advent of fetoscopy, a paradigm shift toward minimally invasive options for antenatal open spina bifida (OSB) correction has been witnessed, resulting in rapid technological innovations and improved outcomes for both the mother and fetus. A history of the minimally invasive surgical management of OSB is presented, with a focus on a novel...

This paper discusses the main advances in fetal surgical therapy aiming to inform health care professionals about the state-of-the-art techniques and future challenges in this field. We discuss the necessary steps of technical evolution from the initial open fetal surgery approach until the development of minimally invasive techniques of fetal endo...

Meningomyelocele is a malformation with high prevalence, and one of its main comorbidities is Arnold-Chiari malformation type II. The intrauterine repair of this defect has been studied to reduce the progressive spinal cord damage during gestation. The purpose of the present review was to describe the evolution of fetal surgery for meningomyelocele...

Objective: rubella during the early stages of pregnancy can lead to severe birth defects known as congenital rubella syndrome (CRS). Samples collected from pregnant women with symptoms and suspected of congenital rubella infection between 1996 and 2008 were analyzed. Methods: a total of 23 amniotic fluid samples, 16 fetal blood samples, 1 product...

ABSTRACT Revision is aimed to describe the effects obtained with fetal neurosurgery, especially in cases of myelomeningocele, promoting a critical analysis of current affairs and prospects available in the literature. Relevant studies were consulted and included in this review. It is observed that the myelomeningocele is the main disease with neuro...

Abstract Objective: To report our preliminary clinical experience in the antenatal correction of open spina bifida using a fetoscopic approach and a simplified closure technique. Methods: Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three t...

To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was co...

OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group...

To assess the ability of a three-layer graft in the closuse of large fetal skin defects. Ovine fetuses underwent a large (4 × 3 cm) full-thickness skin defect over the lumbar region at 105 days' gestation (term = 140 days). A bilaminar artificial skin was placed over a cellulose interface to cover the defect (3-layer graft). The skin was partially...

Objectives: Background: TTTS cases are being treated in Latin America in several centers, following training programs in Europe. Objective: To report the results from fetal therapy centers from three countries. Methods: Fetal therapy centers were invited to report their results. The following information was asked to each: women's ID; date of surge...

Objective: To change the gasless fetoscopy technique in order to reduce the diameter of entry orifices in the myometrium. Methods: Seven pregnant ewes were submitted to fetoscopy for repairing a large skin defect measuring 4.0 × 3.0 cm, created in the fetal lumbar region at the gestational age of 100 days. The defect was repaired through continuou...

To develop a simplified technique for antenatal correction of a meningomyelocele -like defect in fetal sheep to allow direct skin closure. A spinal defect was surgically created at 75 days of gestation in the fetuses of 36 pregnant sheep, 23 survived the surgery. At 102 days gestation, the defect was corrected in 14 cases (9 were left untreated). S...

We retrospectively investigated six cases of discrepancy between prenatal fetal karyotype and postnatal findings. In five cases, the chromosomal abnormalities initially found by CVS or amniocentesis were not confirmed by later analyses and postnatal examination. In one case, the fetal karyotype found to be normal by CVS had to be checked due to son...

To develop a new endoscopic approach to the correction of a myelomeningocele-like defect in fetal sheep. The fetuses of 9 pregnant ewes, with an average gestational age of 115 days, were subjected to a 3.0 x 2.0 cm removal of the skin over the lumbar spine, performed through hysterotomy. The uterus was closed, and three 5-mm endoscopic cannulas, wi...

To produce a myelomeningocele-like human defect in the ovine fetus and validate this experimental model in our population. A prospective study on 12 pregnant sheep of a crossed Hampshire/Down breed where a spinal defect was surgically created between Day 75 and Day 77 after conception. The technique consisted of a hysterotomy with exposure of fetal...

Purpose: The aim of this study was to compare the effectiveness of two dura-mater substitutes, namely human acellular dermal matrix (HADM) and biosynthetic cellulose (BC), in repairing, in utero, surgically-induced meningomyelocele (MMC) in fetal sheep. Methods: A neural tube defect was created at 74-77 days gestation in 36 fetal sheep. They wer...

Objective: To produce a myelomeningocele-like human defect inthe ovine fetus and validate this experimental model in ourpopulation. Methods: A prospective study on 12 pregnant sheep ofa crossed Hampshire/Down breed where a spinal defect wassurgically created between day 75 and day 77 after conception.The technique consisted of a hysterotomy with ex...

To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation. Prospective study of eight cases diagnosed with TTTS evaluated in our service from january 2001 to june 2005. Through percu...

To study the correction of a 'myelomeningocele-like' defect in fetal rabbits. Twelve pregnant rabbits had a spinal defect surgically created in 40 of their fetuses at 23 days of gestation. Immediate repair was performed in 30 fetuses (group I), and 10 remained uncorrected (group II). After 30 days, the fetuses were harvested and the anatomopatholog...

OBJETIVO: Avaliar a sobrevida fetal usando uma nova técnica cirúrgica para criação de um defeito semelhante a meningomielocele em fetos de coelho. MÉTODOS: Foram utilizadas seis coelhas da linhagem Nova Zelândia que tiveram um defeito espinhal criado em seus fetos no 23degrees dia de gestação. O defeito foi criado em 19 fetos e a tentativa de corre...

To investigate presence of trisomy in amniotic epithelium (uncultured amnion) and mesenchyme (cultured amnion) from mosaic cases to understand the origins of these tissues and their relationship to pregnancy outcome. Polymerase chain reaction (PCR) of microsatellite loci was used to determine the presence of trisomy (of meiotic origin only) in amni...

To evaluate the fetal survival rate using a modified technique to surgically create a 'myelomeningocele-like' defect in a rabbit model. Six white New Zealand rabbits had a spinal defect created in their fetuses at 23 days of gestation. At 30 days of gestation, the fetuses were harvested for anatomo-pathologic evaluation. The defect was created in 1...

LRK, 34 years-old, primigravida, had first scan done at 10 weeks 1 day with CRL compatible with 9 weeks + 5 days. At 12 weeks 2 days, nucal translucency measured 1.0 mm, Doppler velocimetry of ductus venosus (positive A wave) showed posite A wave and CRL measured 46 mm (11 weeks 4 days). At 21 weeks + 6 days the anomaly scan revealed dilatation of...

Case reportCATO, 31-year-old, 2G 0P 1 missed abortion (6 weeks). Ultrasound at 13 weeks gestation showed an opened fetal thoraco-abdominal wall, with ectopia cordis and a large omphalocele, severe scoliosis was noticed, suggesting the diagnosis of Pentalogy of Cantrell. Nucal translucency measured 1.5 mm and Doppler velocimetry of the venous ductus...

AimTo emphasize importance of experienced sonographer for detection of fetal anomalies.Materials and method2726 routine scans were performed at 20–24 weeks for the detection of fetal anomalies between February 1997 and May 2000. All scans were performed by five sonographers with more than 10 years' experience and the duration of scan examination wa...

AimTo evaluate the importance of sequential screening in the diagnosis of aneuploidies when maternal age is advanced, but invasive procedure is wanted only if screening tests are altered.Material and methodsWe retrospectively analysed all pregnant patients aged 35 years or more at estimated data of delivery, from July 1996 to June 2000. For those i...

MGB, 34 years-old, primigravida, conceived after IVF (still has 08 frozen embryos). At 21 weeks + 2 days the anomaly scan showed mild dilatation of fetal cerebral ventricles and a multicystic right kidney with mild nasal bone hypoplasia. Fetal growth was considered normal (20 weeks + 3 days based on biometry). Karyotipe obtained at 23 weeks showed...

AimTo determine the accuracy of fetal gender determination between 11–13 weeks of pregnancy.Material and methodsRetrospective evaluation from October 1997 to July 1999. Transabdominal sonography using 3.5–5.0 MHz curvilinear probes. Fetal gender was evaluated at the transverse view of genital region. Male gender was considered when three hiperecoge...

We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such a case. We discuss the long-term ocular sequelae of the condition and how they should affect prenatal counselling.

Objetivos: Avaliar os efeitos da rubéola durante a gestação, sobre o feto, o recém-nascido e a criança. Casuística e Método: Analisamos 35 gestantes com suspeita de rubéola. Grupo 1: 15 pacientes que apresentaram quadro clínico com comprovação sorológica. Grupo 2: 20 pacientes com IgM positiva na rotina pré-natal, na ausência de quadro clínico. Foi...