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Medicina fetala la timpul prezent

Fetal Medicine – video: Prof Ahmet Baschat (ce este medicina fetala, ce este echografia 2D, 3/4D, Doppler, avortul, si o serie de alte informatii corecte foarte frumos explicate – dar in engleza – Click pentru a vizita site-ul de medicina materno-fetala University of Maryland – Medical Centre).

Scurta trecere in revista

The past two decades have witnessed significant advances in the field of fetal medicine. This has revolutionized the management of many conditions. This is an attempt to look at advances in the recent past, changes expected to take place in the near future, at the same time identifying future challenges in fetal medicine.

  • Prenatal screening for chromosomal abnormalities has now reached a high degree of sensitivity and specificity. First trimester screening for trisomy 21 can be provided by a combination of maternal age, nuchal translucency (NT) and maternal serum level of free b-hCG and pregnancy associated plasma protein-A (PAPP-A) at 11+0–13+6 weeks of gestation with a detection rate of ~90% for a false positive rate (FPR) of 5%. The performance of the test has been improved recently by the discovery of additional sonographic markers, such as absent nasal bone, wide fronto-maxillary facial angle, abnormal flow in the ductus venosus and tricuspid regurgitation. An additional benefit of first trimester screening is the early diagnosis of trisomies 18 and 13, which are the second and the third most common chromosomal abnormalities respectively. Screening Trimestru 1 – video: Prof. Kypros Nicolaides
  • The incidence of allo-immunization against RhD antigen has been dramatically reduced from 3% to 0.16% with the advent of postnatal Rh immune prophylaxis. This can be reduced further by antenatal Anti-D administration to Rhesus negative mothers. The measurement of peak systolic velocity (PSV) of blood flow in the middle cerebral artery (MCA) has been shown to be an accurate test for non-invasive detection of fetal anemia. This technique has also been found to be useful in detecting fetal anemia associated with a variety of other conditions such as Kell allo-immunisation, Parvovirus infection, placental chorioangioma, feto-maternal hemorrhage and intrauterine death of one monochorionic twin.
  • Twin-to-twin transfusion syndrome (TTTS) is a complication occurring in 10 – 15% of monochorionic pregnancies. If left untreated, the mortality of this condition exceeds 90%, with significant neurological morbidity in 30–50% of surviving twins. The treatment options for TTTS include serial amnioreduction and fetoscopic laser ablation of the placental vascular anastomoses (vezi poza din dreapta). In 2008, a Cochrane review confirmed the significant increase in survival rates and reduction in neurological morbidity with the use of laser ablation compared with amnioreduction in severe TTTS. This review demonstrated that laser coagulation results in less death of both infants per pregnancy (relative risk (RR) 0.49; 95% confidence interval (CI) 0.30 to 0.79), less perinatal death (RR 0.59; 95% CI 0.0.40 to 0.87) and less neonatal death (RR 0.29; 95% CI 0.14 to 0.61) than in pregnancies treated with amnioreduction. However, 302 laser ablation is a more complex technique and less readily available compared to amnioreduction. TTTS – LASER – video: ChildrenHospitalPhiladelphya

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