Certain congenital heart defects, which present at birth as complex morphologic defects, are actually the result of a relatively simple primary lesion and the subsequent acquired development of a complex secondary lesion during gestation. Moreover, fetal heart approach during gestation can prevent simple cardiac lesions from such development. Specific structural lesions can be diagnosed before 12 weeks of gestation by transvaginal fetal echocardiography, and animal experiments have shown that direct or indirect fetal cardiac approach and fetal cardiac bypass are technically feasible. A number of fetal bypass models have resulted in long-term survivors, with for example, the delivery of normal lambs at full-term gestation. Also, successful full-term delivery has been obtained after fetal cardiac intervention. The success of fetal cardiac bypass was accomplished by the use of total spinal anesthesia and the administration of indomethacin. Moreover, a 42 % long-term survival after fetal cardiopulmonary bypass in a fetal lamb model has been reported. Maternal risk related to fetal bypass should be considered carefully alongside fetal risks and benefits. Most fetal malformations do not directly threaten maternal health, yet the procedures required to address fetal malformations can produce significant maternal risk and discomfort and subsequent pregnancies may be jeopardized. Further investigation of maternal outcome is required. Deep exploration of fetal and maternal pathophysiologic responses to intervention and comprehensive investigation is required to overcome current limitations, and should precede clinical trials as many problems remain to be solved before these techniques can be applied to human beings.
Animal ; Cardiac Surgical Procedures ; Female ; Fetoscopy ; Fetus/*surgery ; Heart Defects, Congenital/*surgery ; Human ; Pediatrics/methods ; Pregnancy

Congenital malformations are one of the main topics, which must be addressed in the 21st century. Fetal surgery is expected to become a routine procedure for malformed fetal patients in the near future. This paper presents some important aspects of the embryological background required for fetal surgery and shows normal human embryos between the 4th and the 8th week of development.
Abnormalities/surgery ; Female ; *Fetal Development ; Fetus/*physiology/*surgery ; Gestational Age ; Human ; Pregnancy ; Pregnancy Trimester, First

Clinical features of 1 case of retroperitoneal parasitic fetus (PF) were retrospectively analyzed and Chinese literatures were reviewed. PF in China has 4 clinical features: 1) The incidence was extremely low and it was more common in infants and children. 2) The parasitic parts showed centrality. 3) The retroperitoneum and abdominal cavity were the most common parasite locations. 4) There was no gender difference in the incidence. Retroperitoneal PF should be distinguished from various benign and malignant abdominal tumors. Imaging was the optimal option for PF diagnosis and the axis bone system was its typical manifestation. Complete excision was the optimal treatment. Thick and large nutrient vessels may be found at where the placenta was attached, and should be ligated carefully. The outcome of this case was good because PF was completely excised.
Child, Preschool ; Congenital Abnormalities ; surgery ; Fetus ; abnormalities ; Humans ; Male ; Retroperitoneal Space ; surgery

BACKGROUND: Frequency and distribution of unexpected red cell antibodies vary according to study population and method of antibody detection. The frequency and specificities of unexpected red cell antibodies were analyzed and compared in adults and children. METHODS: We analyzed the results of antibody screening and identification tests performed from November of 2008 to June of 2015 at Pusan National University Yangsan Hospital. A commercially available three-cell antigen panel, DiaCell I, II and Dia (DiaMed, Murten, Switzerland) for antibody screening, LISS/Coombs and NaCl/Enzyme card and the ID-Dia Panel (DiaMed, Murten, Switzerland) for antibody identification were used. RESULTS: Among the 91,145 adults, 1,804 (1.97%) had positive results for antibody screening test and 11,457 children, 447 (3.90%) had positive results. In adults, the most frequently detected unexpected antibody was anti-E (103 samples), followed by by anti-E&c (51 samples), anti-Lea (27 samples), and anti-Dia (27 samples). In children, anti-M (7 samples), anti-E&c (5 samples), anti-E (4 samples), and anti-D (4 samples) were most frequently detected. Among 9 pediatric patients with anti-E or anti-E&c, 5 patients were proven as hemolytic disease of the fetus and newborn. CONCLUSION: In this study, the positive rate of unexpected antibody screening in children was higher than in adults. Distribution of unexpected antibody differed between children and adults. It may be related to the frequent cardiac surgery performed in children at our hospital. No studies have been conducted in children. Our research may provide data for the frequency and characteristics of red cell antibodies in children.
Adult ; Antibodies* ; Busan ; Child* ; Fetus ; Gyeongsangnam-do ; Humans ; Infant, Newborn ; Mass Screening ; Thoracic Surgery

Many of the anesthetic considerations for fetal procedures and surgery are identical to those for nonobstetric surgery during pregnancy, including concern for maternal safety, avoidance of both teratogenic drugs and fetal asphyxia, and the prevention of preterm labor and delivery. Anesthesia is required for the mother and quite often the fetus to perform many fetal procedures. Fetal procedures and surgery can be divided into subgroups according to their anesthetic requirements. For example: procedures that only require a needle insertion into the uterus but not into the fetus, such as intrauterine infusions; laser surgical photocoagulation of the communicating placental circulation for twin-twin transfusion syndrome (TTTS) and radio-frequency umbilical cord ablation for managing twin reversed arterial perfusion (TRAP), which are not really fetal procedures, rather they are placental or cord procedures; surgical procedures performed directly on the fetus; and the EX-utero Intrapartum Treatment (EXIT) procedure. Anesthetic considerations also depend on other factors, such as the location of the placenta. Unlike maternal surgery, for fetal procedures, the fetus is not an innocent bystander for whom the least anesthetic interference is used. Instead, the fetus can be the primary patient and may benefit from anesthesia, with close monitoring of the anesthetic effects to ensure well-being. Fetal asphyxia, hypoxia, or distress can be most effectively recognized, predicted, and avoided by fetal monitoring. Monitoring is also crucial for assessing the fetal response to corrective maneuvers.
*Anesthesia ; Animal ; Female ; Fetal Diseases/*diagnosis/*therapy ; Fetus/*surgery ; Human ; Pregnancy ; *Prenatal Diagnosis

Craniosynostosis occurs in approximately 1:2000 live births. It may affect the coronal, sagittal, metopic and lambdoid sutures in isolation or in combination. Although non-syndromic synostoses are more common, over 150 genetic syndromes have been identified. Recent advances in genetic mapping have linked chromosomal mutations with craniosynostotic syndromes. Despite the identification of these genetic mutations, the fundamental biomolecular mechanisms mediating cranial suture biology remain unknown. Today, many laboratories are investigating murine cranial suture biology as a model for human cranial suture development and fusion. Normal murine cranial suture biology is very complex, but evidence suggests that the dura mater provides the biomolecular blueprints (e.g. the soluble growth factors), which guide the fate of the pleuripotent osteogenic fronts. While our knowledge of these dura-derived signals has increased dramatically in the last decade, we have barely begun to understand the fundamental mechanisms that mediate cranial suture fusion or patency. Interestingly, recent advances in both premature human and programmed murine suture fusion have revealed unexpected results, and have generated more questions than answers.
Animal ; Craniosynostoses/*etiology/genetics/surgery ; Fetal Development ; Fetus/*physiology ; Human ; Mutation

The development and evolution of fetal surgery and the recognition of the fetus as a patient came from two sources. First, were those obstetricians and perinatologists who detected life threatening anomalies before birth, and re-described a hidden mortality arising from death in utero. Ultrasonography, color Doppler ultrasound and ultrafast fetal magnetic resonance imaging have since enhanced the accuracy of prenatal evaluation. Second, were those pediatricians responsible for treating newborn infants with extremely serious problems, and that appeared untreatable, although, it was believed that they could have been treated at an earlier stage of development. After the natural history of several correctable lesions had been determined and the selection criteria for intervention developed, fetal surgery emerged as a means of improving the overall morbidity and mortality rates.
Cystic Adenomatoid Malformation of Lung, Congenital/surgery ; Fetal Diseases/*surgery ; Fetus/*surgery ; Hernia, Diaphragmatic/congenital/surgery ; Human ; Postoperative Care ; Preoperative Care ; Sacrococcygeal Region ; Spinal Neoplasms/embryology/surgery ; Teratoma/embryology/surgery

Open heart surgery during pregnancy can adversely affect both the mother and the fetus by the cardiopulmonary bypass process. We experienced a redo open heart surgery for prosthetic valve failure in the third trimester of pregnancy. Cesarean section was performed 20 hours prior to the cardiac reoperation and both the mother and the baby recovered uneventfully.
Cardiopulmonary Bypass ; Cesarean Section ; Female ; Fetus ; Heart* ; Humans ; Mothers ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women* ; Reoperation ; Thoracic Surgery*

In utero hematopoietic stem cell transplantation (IUHSCTx) is a promising approach for the treatment of a potentially large number of fetuses affected by congenital hematologic disorders. With technical advances in prenatal diagnosis and fetal intervention, the majority of these diseases can now be diagnosed early in gestation, allowing consideration of prenatal treatment. It, therefore, stands to reason that there is increasing interest in performing in utero hematopoietic stem cell transplantation at many centers around the world. Although the approach remains experimentally promising, expansion of clinical application will depend on improved understanding of the biological barriers to engraftment in the fetus as well as on the development of effective clinical strategies based on the hematopoietic biology of individual disorders.
Animal ; Bioethics ; Fetal Diseases/*surgery ; Fetus/immunology ; *Hematopoietic Stem Cell Transplantation/adverse effects ; Human ; Risk Factors ; Transplantation Immunology

OBJECTIVE: To assess the value of fetal anteroposterior renal pelvic diameter (APD) in predicting antenatal hydronephrosis requiring surgical treatment after birth. METHODS: A total of 525 cases of antenatal hydronephrosis detected by prenatal ultrasonography (ultrasound index APD ≥ 4 mm in the second trimester and APD ≥ 7 mm in the third trimester) in Zhejiang Prenatal Diagnosis Center from June 2007 to June 2018 were retrospectively analyzed. ROC curve was used to analyze the relationship between these ultrasound indicators and the requirement for surgical treatment after birth. RESULTS: There were 162 cases (30.9%) diagnosed in the second trimester and 363 cases (69.1%) diagnosed in the third trimester; 131 cases were diagnosed pathologically after birth, of which 121 finally underwent surgical treatment. The area under ROC curve (AUC) of APD in middle pregnancy for prediction of requiring surgery 1-12 years after birth was 0.910; the cut-off value of APD was 8.45 mm with a sensitivity of 97.1%, specificity of 70.9%, positive predictive value (PPV) of 47.9%, and negative predictive value (NPV) of 98.9%. The AUC of APD in late pregnancy for prediction of requiring surgery 1-12 years after birth was 0.800; the cut-off value of APD was 12.25 mm with a sensitivity of 66.7%, specificity of 81.2%, PPV of 51.7%, and NPV of 89.1%. CONCLUSIONS APD in pregnancy can be used to predict whether the fetus with hydronephrosis needs surgical treatment after birth, and the prediction value of APD in the middle pregnancy is better.
Female ; Fetus ; diagnostic imaging ; Humans ; Hydronephrosis ; diagnostic imaging ; surgery ; Kidney Pelvis ; diagnostic imaging ; Pregnancy ; Retrospective Studies ; Ultrasonography