Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP RUANO, Rodrigo FMUSP-HC
DUARTE, Sergio Aluisio
PIMENTA, Eduardo Jorge de Almeida FMUSP-HC
SILVA, Marcos Marques da FMUSP-HC
ZUGAIB, Marcelo FMUSP-HC 2011
dc.identifier.citation FETAL DIAGNOSIS AND THERAPY, v.29, n.1, p.64-70, 2011
dc.identifier.issn 1015-3837
dc.description.abstract Objectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28-38) weeks in the FETO group and at 37.5 (range: 31-40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.
dc.description.sponsorship · National Council for Scientific and Technological Development of Brazil (Conselho Nacional de Desenvolvimento de Pesquisa e Tecnologia do Brasil)
dc.language.iso eng
dc.publisher KARGER
dc.relation.ispartof Fetal Diagnosis and Therapy
dc.rights restrictedAccess
dc.subject Congenital diaphragmatic hernia; Fetal endoscopic tracheal occlusion; Fetoscopy; Liver herniation; Lung surgery; Pulmonary hypoplasia
dc.subject.other to-head ratio; persistent pulmonary-hypertension; intrapartum treatment procedure; lung-volume; 3-dimensional ultrasonography; circumference ratio; fetuses; prediction; survival; diagnosis
dc.title Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia
dc.type article
dc.rights.holder Copyright KARGER LIM/30 LIM/57
dc.identifier.doi 10.1159/000311944
dc.identifier.pmid 20389048
dc.type.category review
dc.type.version publishedVersion RUANO, Rodrigo:FM:MOG PIMENTA, Eduardo Jorge de Almeida:FM: TAKASHI, Eduardo:FM: SILVA, Marcos Marques da:HC:ICR TANNURI, Uenis:FM:MPE ZUGAIB, Marcelo:FM:MOG · DUARTE, Sergio Aluisio:Univ Sao Paulo, Fac Med, Dept Obstet, BR-03184090 Sao Paulo, Brazil 2-s2.0-79951783549 WOS:000287783000008 BASEL SWITZERLAND
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dc.description.index MEDLINE
hcfmusp.citation.scopus 52 Brasil
hcfmusp.scopus.lastupdate 2021-08-27

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