Mielomeningocele. Técnica Quirúrgica. Dr. Alberto Ramírez Espinoza. Lima-Perú – Duration: Alberto Ramírez Espinoza 18, views. CORRECCIÓN DEL MIELOMENINGOCELE POR MEDIO DE CIRUGÍA FETAL INTRAUTERINA. No description. CIRUGIA PRENATAL DE MIELOMENINGOCELE. Original Article A Randomized Trial of Prenatal versus Postnatal Repair of.
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Pregnancy among mothers with spina bifida.
GENETICA Y SEXOLOGIA INTEGRAL: CIRUGIA PRENATAL DE MIELOMENINGOCELE
On both the Bayley and Peabody motor scales, the prenatal-surgery group had better motor function than the postnatal-surgery group, even though those in the prenatal-surgery group had more severe anatomical levels of lesions. The most frequent form is myelomeningocele, characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid, resulting in lifelong disability. Movement in the lower limbs may be lost, and hindbrain herniation and hydrocephalus may worsen during fetal gestation.
The study protocol, including the statistical analysis plan and full inclusion and exclusion criteria, is available with the full text of this article at NEJM. Ranges of scores and implications of higher scores mielomeningcele provided in Table 4Table 4 Outcomes of Children at 30 Months.
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The Bayley scores were ranked across all infants, with fetal, neonatal, or infant deaths being assigned the lowest rank. In our study, prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months, but the early intervention was associated with both maternal and fetal morbidity.
Hydrocephalus is treated by diverting cerebrospinal fluid to the peritoneal cavity by the surgical mielomeningoce,e of a shunt, which then requires lifelong monitoring.
Finally, for the children in this study, continued follow-up is needed to assess whether the early benefits are durable and to evaluate the effect of prenatal intervention on bowel and bladder continence, sexual function, and mental capacity. Current selection criteria and perioperative therapy used for fetal myelomeningocele surgery. Since uterine dehiscence and rupture in a subsequent pregnancy are recognized risks of prenatal surgery,21 mothers who undergo prenatal surgery must understand that all subsequent pregnancies should be delivered by cesarean before the onset of labor.
Risk factors, prenatal screening and diagnosis, and pregnancy management. Childs Nerv Syst ; We analyzed the time to shunt placement or meeting shunt criteria using Kaplan—Meier survival curves and log-rank tests. Fetuses that were treated prenatally were born at an average gestational age of Early data suggested a dramatic improvement in hindbrain herniation in comparison with historic controls but also showed an increased maternal risk, including preterm labor and uterine dehiscence, and a substantially increased risk of fetal or neonatal death and preterm birth.
This malformation is also associated with hydrocephalus and developmental brain abnormalities. The same cirugka was separately conducted for the calculated difference between functional and anatomical level. National Institute of Neurological Disorders and Stroke.
Espina bífida – Diagnóstico y tratamiento – Mayo Clinic
One primary outcome was a composite of cirugiq or neonatal death or the citugia for placement of a cerebrospinal fluid shunt by the age of 12 months. Mkelomeningocele complications in the first postoperative year in children with meningomyelocele. The anatomical level of the lesion was determined by an independent group of radiologists on the basis of the month radiograph.
Surgical revisions are common to address shunt failure or infection. Damage to the spinal cord and peripheral nerves usually is evident at birth and is irreversible despite early postnatal surgical repair.
However, one fifth of those in the prenatal-surgery group had evidence of the respiratory distress syndrome, which was probably caused by prematurity. The results of this trial should not be generalized to patients who undergo procedures at less experienced centers or who do not meet the eligibility criteria.
The trial was approved by the institutional review board at each center. Pregnancy and Neonatal Complications There were no maternal miellmeningocele. The first outcome, at 12 months, was a composite of fetal or neonatal death or the need for a cerebrospinal fluid shunt either placement of the shunt or meeting objective criteria for its placement for details, see the Supplementary Appendix.
All children were evaluated at 12 and 30 months of age on the basis of physical and neurologic examinations and developmental testing.
Previous cohort studies have suggested improved outcomes with prenatal surgery for myelomeningocele. Women in the prenatal-surgery group stayed nearby with a support person until cesarean delivery at 37 weeks of gestation if still undeliveredwhereas women in the postnatal-surgery group went home and returned to the center at 37 weeks for cesarean delivery and postnatal repair by the same surgical team.
Reductions in rates of shunt placement or need for shunting in the prenatal-surgery group were probably due to the reduction in rates of hindbrain herniation and improved flow of cerebrospinal fluid. An independent pediatrician determined the functional level of the lesion by assessing motorsensory and distal somatosensory function, a determination that was confirmed by videotape review by an independent expert.
The trial was stopped for efficacy of prenatal surgery after the recruitment of of a planned patients. The data and safety monitoring committee met on December 7,and recommended termination of the trial on the basis of efficacy of prenatal surgery. There were no significant between-group differences in cognitive scores. Another primary outcome at 30 months was a composite of mental development and motor function.
An independent data and safety monitoring committee monitored the trial. This approach minimizes blood loss and, in contrast with the use of metal staples, does not impair subsequent fertility. Trained independent pediatricians and psychologists who were unaware mielomeningkcele study-group assignments and who reported directly to the coordinating center conducted the testing. For outcomes up to 30 months, the report is based on the findings in women who underwent randomization before December 1, The rates of adverse neonatal outcomes were generally similar between the two groups.
Ferri’s Clinical Advisor Shepard CL, et al.
Journal of Pediatric Urology. Preterm labor leading to early delivery, placental abruption, and pulmonary edema associated with tocolytic therapy are well-known complications of prenatal surgery. The difference between the functional level and anatomical level in vertebral segments was calculated. The second primary outcome, at 30 months, was a composite score of the Mental Development Index of the Bayley Scales of Infant Development II and the child’s motor function, with adjustment for lesion level.
Tal vez, sea necesario mieelomeningocele adaptaciones durante el proceso, pero alienta a tu hijo a ser tan independiente como sea posible. In the postnatal-surgery group, two neonates died, both with severe symptoms of the Chiari II malformation; both had received shunts.