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Revista Brasileira de Ginecologia e Obstetrícia. 07-10-2023;45(2):096-103
, , , , This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-10-2023;45(2):096-103
, , , , This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
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Revista Brasileira de Ginecologia e Obstetrícia. 04-14-2023;45(1):49-54
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Revista Brasileira de Ginecologia e Obstetrícia. 04-14-2023;45(1):49-54
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Revista Brasileira de Ginecologia e Obstetrícia. 11-29-2021;43(9):713-723
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-29-2021;43(9):713-723
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Revista Brasileira de Ginecologia e Obstetrícia. 03-08-2021;43(1):74-79
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Revista Brasileira de Ginecologia e Obstetrícia. 03-08-2021;43(1):74-79
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Revista Brasileira de Ginecologia e Obstetrícia. 03-06-2006;27(3):149-154
DOI 10.1590/S0100-72032005000300009
PURPOSE: to analyze the efficacy, safety and real advantage of vesicoamniotic shunt catheter in the intrauterine treatment of obstructive uropathy. METHODS: a retrospective and descriptive study, in which the evolution of 35 fetuses with obstructive uropathy, submitted to vesicoamniotic shunt from 1990 to 2004 in a Fetal Medical Center was evaluated. All these fetuses fitted the selection criteria defined by a protocol of this service, and had the parents' consent for the procedure. The Pediatric Nephrology Sector of the Hospital das Clínicas of UFMG assessed all of them after delivery to confirm the prenatal diagnosis and outcome. The dead neonates were studied by the Pathological Anatomy Sector of UFMG. Descriptive analysis of the following parameters was performed: prenatal diagnosis of the uropathy, gestational age at shunt insertion, time of catheter utilization, post-surgery complications, perinatal mortality and neonatal survival. RESULTS: posterior urethral valve was the most common uropathy (62.8%). The mean gestational age at the vesicoamniotic shunt placement was 26.1weeks and the mean time of its presence was 46 days (1-119 days). There were four intrauterine fetal deaths and 17 in the neonatal period (60% perinatal mortality). The main cause of death was pulmonary hypoplasia. Olygohidramnios was present in 33/35 fetuses (94.3%) and it was reversed in 23 of them (70%); fourteen fetuses survived the neonatal period. At present, there are 4 children followed up by the Pediatric Sector of Nephrology of Hospital das Clínicas. Two of them have been treated with peritoneal dialysis, awaiting renal transplantation. The other two have normal renal function. Their age varies from 2 months to 4 years. CONCLUSION: the vesicoamniotic shunt may be a viable intrauterine treatment for severe obstructive uropathy, with 40% of survival rate of fetuses that might have progressed to death. However, the procedure's success was directly related to the adequate selection, and to the early intervention in the uterus, performed before 32 weeks of gestation in fetuses with bilateral obstruction, without any associated malformation and with still preserved renal function. Olygohidramnios reversion did not guarantee a good prognosis. It remains controversial if the vesicoamniotic shunt can really ensure long-term renal function.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-06-2006;27(3):149-154
DOI 10.1590/S0100-72032005000300009
PURPOSE: to analyze the efficacy, safety and real advantage of vesicoamniotic shunt catheter in the intrauterine treatment of obstructive uropathy. METHODS: a retrospective and descriptive study, in which the evolution of 35 fetuses with obstructive uropathy, submitted to vesicoamniotic shunt from 1990 to 2004 in a Fetal Medical Center was evaluated. All these fetuses fitted the selection criteria defined by a protocol of this service, and had the parents' consent for the procedure. The Pediatric Nephrology Sector of the Hospital das Clínicas of UFMG assessed all of them after delivery to confirm the prenatal diagnosis and outcome. The dead neonates were studied by the Pathological Anatomy Sector of UFMG. Descriptive analysis of the following parameters was performed: prenatal diagnosis of the uropathy, gestational age at shunt insertion, time of catheter utilization, post-surgery complications, perinatal mortality and neonatal survival. RESULTS: posterior urethral valve was the most common uropathy (62.8%). The mean gestational age at the vesicoamniotic shunt placement was 26.1weeks and the mean time of its presence was 46 days (1-119 days). There were four intrauterine fetal deaths and 17 in the neonatal period (60% perinatal mortality). The main cause of death was pulmonary hypoplasia. Olygohidramnios was present in 33/35 fetuses (94.3%) and it was reversed in 23 of them (70%); fourteen fetuses survived the neonatal period. At present, there are 4 children followed up by the Pediatric Sector of Nephrology of Hospital das Clínicas. Two of them have been treated with peritoneal dialysis, awaiting renal transplantation. The other two have normal renal function. Their age varies from 2 months to 4 years. CONCLUSION: the vesicoamniotic shunt may be a viable intrauterine treatment for severe obstructive uropathy, with 40% of survival rate of fetuses that might have progressed to death. However, the procedure's success was directly related to the adequate selection, and to the early intervention in the uterus, performed before 32 weeks of gestation in fetuses with bilateral obstruction, without any associated malformation and with still preserved renal function. Olygohidramnios reversion did not guarantee a good prognosis. It remains controversial if the vesicoamniotic shunt can really ensure long-term renal function.