nach oben

Erschienen in:

2016 | OriginalPaper | Buchkapitel

17. Der Fetus als Patient - Chirurgische und medikamentöse Therapie

verfasst von : Thomas Kohl, Ulrich Gembruch

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Durch pränatalmedizinische Diagnostik werden zahlreiche Schwangere – meistens viele Wochen vor dem errechneten Geburtstermin – mit dem Vorliegen lebensbedrohlicher oder die nachgeburtliche Lebensqualität ihrer Ungeborenen erheblich beeinträchtigender Erkrankungen konfrontiert. Diese Problematik hat über die letzten Jahrzehnte zahlreiche Wissenschaftler dazu inspiriert, chirurgische und medikamentöse Therapien zur Verbesserung der Prognose betroffener Ungeborener zu entwickeln. Während sich viele der chirurgischen Therapien aufgrund ihrer oft nur seltenen Anwendung sowie des Fehlens geeigneter Interventionsmaterialien oder auch Selektionskriterien noch in frühen Entwicklungsstadien befinden, sind medikamentöse Therapien aufgrund ihrer häufigeren Verwendung, ihrer weiteren Verbreitung und ihres öfter dokumentierten therapeutischen Vorteils schon nahezu als etablierte Verfahren anzusehen. Das Kapitel gibt eine kurze Übersicht über eine Auswahl vorgeburtlicher Behandlungsmöglichkeiten.

Vorheriges Kapitel Früher vorzeitiger Blasensprung

Nächstes Kapitel Fetale Wachstumsrestriktion (FGR)

Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL, MOMS Investigators (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004CrossRefPubMedPubMedCentral

Allan LD, Maxwell DJ, Carminati M, Tynan MJ (1995) Survival after fetal aortic balloon valvoplasty. Ultrasound Obstet Gynecol 5:90–91CrossRefPubMed

Arzt W, Wertaschnigg D, Veit I, Klement F, Gitter R, Tulzer G (2011) Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures. Ultrasound Obstet Gynecol 37:689–695CrossRefPubMed

Berg C, Geipel A, Kohl T, Breuer J, Germer U, Krapp M, Baschat AA, Hansmann M, Gembruch U (2005a) Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers. Ultrasound Obstet Gynecol 26:4–15CrossRefPubMed

Berg C, Geipel A, Kamil D, Knüppel M, Breuer J, Krapp M, Baschat A, Germer U, Hansmann M, Gembruch U (2005b) The syndrome of left isomerism: sonographic findings and outcome in prenatally diagnosed cases. J Ultrasound Med 24:921–931PubMed

Biard JM, Johnson MP, Carr MC, Wilson RD, Hedrick HL, Pavlock C, Adzick NS (2005) Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction. Obstet Gynecol 106:503–508CrossRefPubMed

Bruner JP, Tulipan N (2004) Tell the truth about spina bifida. Ultrasound Obstet Gynecol 24:595–596CrossRefPubMed

Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG (2005) Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 105:239–245CrossRefPubMed

Clark TJ, Martin WL, Divakaran TG, Whittle MJ, Kilby MD, Khan KS (2003) Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis. Obstet Gynecol 102:367–382PubMed

Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R (2003) Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn 23:740–742CrossRefPubMed

Crombleholme TM, Dirkes K, Whitney TM, Alman B, Garmel S, Connelly RJ (1995) Amniotic band syndrome in fetal lambs I: fetoscopic release and morphometric outcome. J Pediatr Surg 30:974–978CrossRefPubMed

Danzer E, Finkel RS, Rintoul NE, Bebbington MW, Schwartz ES, Zarnow DM, Adzick NS, Johnson MP (2008) Reversal of hindbrain herniation after maternal-fetal surgery for myelomeningocele subsequently impacts on brain stem function. Neuropediatrics 39:359–362CrossRefPubMed

Degenhardt J, Schürg R, Winarno A, Oehmke F, Khaleeva A, Kawecki A, Enzensberger C, Tinneberg HR, Faas D, Ehrhardt H, Axt-Fliedner R, Kohl T (2014) Percutaneous minimally-invasive fetoscopic surgery for spina bifida aperta – part II maternal management and outcome. Ultrasound Obstet Gynecol 44:525–531

Deprest J, Gratacos E, Nicolaides KH (2004) Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol 24:121–126CrossRefPubMed

Duncombe GL, Dickinson JE (2001) Fetal thyrotoxicosis after maternal thyroidectomy. Aust NZ J Obstet Gynaecol 41:224–227CrossRef

Forest MG, David M, Morel Y (1993) Prenatal diagnosis and treatment of 21-hydroxylase deficiency. J Steroid Biochem Mol Biol 45:75–82CrossRefPubMed

Freud LR, McElhinney DB, Marshall AC, Marx GR, Friedman KG, del Nido PJ, Emani SM, Lafranchi T, Silva V, Wilkins-Haug LE, Benson CB, Lock JE, Tworetzky W (2014) Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: postnatal outcomes of the first 100 patients. Circulation 130:638–645CrossRefPubMedPubMedCentral

Friedman DM, Kim MY, Copel JA, Llanos C, Davis C, Buyon JP (2009) Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) study. Am J Cardiol 103:1102–1106CrossRefPubMedPubMedCentral

Gembruch U (2009) Fetal tachyarrhythmia. In: Yagel S, Silverman N, Gembruch U (Hrsg) Fetal cardiology, 2. Aufl. Informa Health Care, New York, S 435–447

Gembruch U, Geipel A (1999) Die indirekte und direkte medikamentöse Therapie des Fetus. Gynakologe 32:840–854

Gembruch U, Somville T (1995) Intrauterine Diagnostik und Therapie fetaler Arrhythmien. Gynakologe 28:329–345PubMed

Gorincour G, Bouvenot J, Mourot MG, Sonigo P, Chaumoitre K, Garel C, Guibaud L, Rypens F, Avni F, Cassart M, Maugey-Laulom B, Bourliere-Najean B, Brunelle F, Durand C, Eurin D (2005) Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume. Ultrasound Obstet Gynecol 26:738–744CrossRefPubMed

Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O´Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD, Klein RZ (1999) Maternal thyroid defiency during pregancy and subsequent neurophysiological development of the child. N Engl J Med 341:549–555CrossRefPubMed

Hatijs CG (1993) Diagnosis and successful treatment of fetal goitrous hyperthyreoidism caused by maternal Graves disease. Obstet Gynecol 81:837–839

Izmirly PM, Kim MY, Llanos C, Le PU, Guerra MM, Askanase AD, Salmon JE, Buyon JP (2010) Evaluation of the risk of anti-SSA/Ro-SSB/La anti-body associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposes to hyroxychloroquine 69:1827–1830

Jani J, Nicolaides KH, Keller RL, Benachi A, Peralta CF, Favre R, Moreno O, Tibboel D, Lipitz S, Eggink A, Vaast P, Allegaert K, Harrison M, Deprest J (2007) Observed to expected lung area to head circumference ratio in the prediction of survival in isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 30:67–71CrossRefPubMed

Jani JC, Nicolaides KH, Gratacos E, Valencia CM, Done E, Martinez JM, Gucciardo L, Cruz R, Deprest JA (2009) Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 34:304–310CrossRefPubMed

Kilby M, Khan K, Morris K, Daniels J, Gray R, Magill L, Martin B, Thompson P, Alfirevic Z, Kenny S, Bower S, Sturgiss S, Anumba D, Mason G, Tydeman G, Soothill P, Brackley K, Loughna P, Cameron A, Kumar S, Bullen P (2007) PLUTO trial protocol: percutaneous shunting for lower urinary tract obstruction randomised controlled trial. Br J Obstet Gynaecol 114:904–905, e1–4CrossRef

Kilian AL, Schaible T, Hofmann V, Brade J, Neff KW, Büsing KA (2009) Congenital diaphragmatic hernia: predictive value of MRI relative lung-to-head ratio compared with MRI fetal lung volume and sonographic lung-to-head ratio. AJR Am J Roentgenol 192:153–158CrossRefPubMed

Kohl T (2002) Fetal echocardiography – new grounds to explore during fetal cardiac intervention. Pediatr Cardiol 23:334–346CrossRefPubMed

Kohl T (2008) Mending the tiniest hearts – an overview. In: Yagel S, Silverman N, Gembruch U (Hrsg) Fetal cardiology, 2. Aufl. Informa Health Care, New York

Kohl T (2014) Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. Ultrasound Obstet Gynecol 44:515–524CrossRefPubMed

Kohl T, McElhinney DB, Farrel J, Harrison MR, Scheld HH, Vogt J, Silverman NH (1998) Fetoplacental blood flow predicts outcome after open fetal surgery for diaphragmatic hernia in human fetuses. Pediatr Res 43:23ACrossRef

Kohl T, McElhinney DB, Farrel J, Scheld HH, Vogt J, Harrison MR, Silverman NH (1999) Impact of fetoscopic versus open fetal surgery on fetoplacental blood flow and outcome in human fetuses. Eur Heart J 20(Abstract Suppl):644A

Kohl T, Sharland G, Allan LD, Gembruch U, Chaoui R, Lopes LM, Zielinsky P, Huhta J, Vogt J, Scheld HH, Silverman NH (2000) World experience of fetal cardiac intervention in human fetuses with severe aortic valvar obstruction. Am J Cardiol 85:1230–1233CrossRefPubMed

Kohl T, Hering R, Bauriedel G et al (2005a) Percutaneous fetoscopic and ultrasound-guided decompression of the fetal trachea permits normalization of fetal hemodynamics in a human fetus with Fraser syndrome and congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia. Ultrasound Obstet Gynecol 27:84–88CrossRef

Kohl T, Müller A, Tchatcheva K, Achenbach S, Gembruch U (2005b) Fetal transesophageal echocardiography – clinical introduction as a monitoring tool during fetal cardiac intervention in a human fetus. Ultrasound Obstet Gynecol 26:780–785CrossRefPubMed

Kohl T, Gembruch U, Filsinger B, Hering H, Bruhn J, Tchatcheva K, Aryee S, Franz A, Heep A, Müller A, Bartmann P, Loff S, Hosie S, Neff W, Schaible S (2006) Early clinical experience with deliberately delayed temporary fetoscopic tracheal occlusion for the prenatal treatment of life-threatening right and left congenital diaphragmatic hernias. Fetal Diagn Ther 21:314–318CrossRefPubMed

Kohl T, Tchatcheva K, Stressig R, Geipel A, Heitzer S, Gembruch U (2008) Maternal hyperoxygenation in late gestation promotes rapid increase of cardiac dimensions in fetuses with hypoplastic left hearts with intrinsically normal or slightly abnormal aortic and mitral valves. Ultraschall Med 29:92CrossRef

Kohl T, Tchatcheva K, Merz W, Wartenberg HC, Heep A, Müller A, Franz A, Stressig R, Willinek W, Gembruch U (2009) Percutaneous fetoscopic patch closure of spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical closure. Surg Endosc 23:890–895CrossRefPubMed

Kohl T, Tchatcheva K, Weinbach J, Hering R, Kozlowski P, Stressig R, Gembruch U (2010) Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans. Surg Endosc 24:432–444

Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U (2003) Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 89:913–917CrossRefPubMedPubMedCentral

Lim FY, Crombleholme TM, Hedrick HL, Flake AW, Johnson MP, Howell LJ, Adzick NS (2003) Congenital high airway obstruction syndrome: natural history and management. J Pediatr Surg 38:940–945CrossRefPubMed

Luks FI, Peers KH, Deprest JA, Lerut TE, Vandenberghe K (1999) The effect of open and endoscopic fetal surgery on uteroplacental oxygen delivery in the sheep. J Pediatr Surg 31:310–314CrossRef

Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, Toubert ME, Léger J, Boissinot C, Schlageter MH, Garel C, Tébeka B, Oury JF, Czernichow P, Polak M (2005) Management of graves’ disease during pregancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 90:6093–6098CrossRefPubMed

Marshall AC, Levine J, Morash D, Silva V, Lock JE, Benson CB, Wilkins-Haug LE, McElhinney DB, Tworetzky W (2008) Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn 28(11):1023–1028CrossRefPubMed

McElhinney DB, Marshall AC, Wilkins-Haug LE, Brown DW, Benson CB, Silva V, Marx GR, Mizrahi-Arnaud A, Lock JE, Tworetzky W (2009) Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation 120(15):1482–1490CrossRefPubMedPubMedCentral

Morreale de Escobar G, Obregón MJ, Escobar del Rey F (2004) Role of thyroid hormaone during early brain development. Eur J Endocrinol 151:U25–U37CrossRefPubMed

Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K, Burke D, Daniels JP, Khan KS, Deeks J, Kilby MD, Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) Collaborative Group (2013) Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 382(9903):1496–1506CrossRefPubMedPubMedCentral

Nachum Z, Rakover Y, Weiner E, Shalev E (2003) Graves´ disease in pregancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol 189:159–165CrossRefPubMed

Peleg D, Cada S, Peleg A, Ben-Ami M (2002) The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis. Obstet Gynecol 99:1040–1043PubMed

Perelman AH, Johnson RL, Clemons RD, Finberg HG, Clewell WH, Trujillo L (1990) Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism. J Clin Enocrinol Metab 71:618–621CrossRef

Poppe K, Glinoer D (2003) Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update 9:149–161CrossRefPubMed

Quintero RA, Hume R, Smith C, Johnson MP, Cotton DB, Romero R, Evans MI (1995) Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol 172:206–209CrossRefPubMed

Quintero RA, Morales WJ, Phillips J, Kalter CS, Angel JL (1997) In utero lysis of amniotic bands. Ultrasound Obstet Gynecol 10:316–320CrossRefPubMed

Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M (1999) Staging of twin-twin transfusion syndrome. J Perinatol 19:550–555CrossRefPubMed

Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, Gorret SM, Greenough A, Tibboel D, CDH EURO Consortium (2010) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 98:354–364CrossRefPubMed

Roberts D, Neilson JP, Kilby M, Gates S (2008) Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev 23:CD002073

Ruano R1, Yoshisaki CT, da Silva MM, Ceccon ME, Grasi MS, Tannuri U, Zugaib M (2012) A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 39:20–27CrossRefPubMed

Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y (2004) Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Eng J Med 351:136–144CrossRef

Singh PK, Parvin CA, Gronowski AM (2003) Establishment of reference intervals for markers of fetal thyroid status in amniotic fluid. J Clin Endocrinol Metab 88:4175–4179CrossRefPubMed

Slaghekke F, Kist WJ, Oepkes D, Middeldorp JM, Klumper FJ, Vandenbussche FP, Lopriore E (2009) Z Geburtshilfe Neonatol 213:248–254CrossRefPubMed

Stressig R, Tchatcheva K, Van de Vondel P, Berg C, Geipel A, Gembruch U, Kohl T (2008) Fetoscopic surgery in amniotic band syndrome – a tale of two cases and conclusions drawn for fetal selection. Ultraschall Med 29:120

Stulberg RA, Davies GA (2000) Maternal thyrotoxicosis and fetal nonimmune hydrops. Obstet Gynecol 95:1036PubMed

Tubbs RS, Chambers MR, Smyth MD, Bartolucci AA, Bruner JP, Tulipan N, Oakes WJ (2003) Late gestational intrauterine myelomeningocele repair does not improve lower extremity function. Pediatr Neurosurg 38:128–132CrossRefPubMed

Tworetzky W, Wilkins-Haug L, Jennings RW, van der Velde ME, Marshall AC, Marx GR, Colan SD, Benson CB, Lock JE, Perry SB (2004) Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation 110:2125–2131CrossRefPubMed

Verbeek RJ, Heep A, Maurits NM, Cremer R, Hoving EW, Brouwer OF, van der Hoeven JH, Sival DA (2012) Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Dev Med Child Neurol 54:15–22CrossRefPubMed

Vogel M, McElhinney DB, Wilkins-Haug LE, Marshall AC, Benson CB, Juraszek AL, Silva V, Lock JE, Marx GR, Tworetzky W (2011) Aortic stenosis and severe mitral regurgitation in the fetus resulting in giant left atrium and hydrops: Pathophysiology, outcomes, and preliminary experience with pre-natal cardiac intervention 57:348–355

Walsh DS, Adzick NS, Sutton LN, Johnson MP (2001) The rationale for in utero repair of myelomeningocele. Fetal Diagn Ther 16:312–322CrossRefPubMed

Yanai N, Shveiky D (2004) Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol 23:198–201CrossRefPubMed

Titel: Der Fetus als Patient - Chirurgische und medikamentöse Therapie
verfasst von: Thomas Kohl
Ulrich Gembruch
Verlag: Springer Berlin Heidelberg
Buch: Die Geburtshilfe
Print ISBN: 978-3-662-45063-5

Electronic ISBN: 978-3-662-45064-2

Copyright-Jahr: 2016
DOI: https://doi.org/10.1007/978-3-662-45064-2_17

Springerpflege

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten