Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile.

Objective: To report the experience with prenatal repair of open spina bifida (OSB) from 2 centers in Chile.

Methods: Women with a second-trimester fetus with OSB were offered intrauterine neurosurgical repair following the protocol from the Management of Myelomeningocele Study (MOMS) trial. Pediatric follow-up with infants reaching 12 and 30 months of life was also reviewed.

Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery.

Accurate and timely prenatal diagnosis of spina bifida (SB) is a major goal of modern antenatal care. Prenatal screening for open SB should be first performed at the time of routine first-trimester ultrasound by examining the posterior fossa for obliteration or non-visualization of the fourth ventricle ("intracranial translucency") and cisterna magna. The second step of screening is the second-trimester anatomy scan, at which time the features of the Chiari type II malformation should be looked for, including ventriculomegaly, scalloping of the frontal bones ("lemon" sign), and backward and caudal displacement of the cerebellar vermis with obliteration of the cisterna magna ("banana" sign).

Anesthesia for myelomeningocele surgery in fetus.

Background: Administering anesthesia for prenatal repair of myelomeningocele reveals several issues that are unique to this new form of treatment. This includes issues such as fetal well-being, surgical conditions and monitoring, among others. Exploring, analyzing, and understanding the different variables that are involved will help us reduce the high level of risk associated with this surgery.

Acardiac fetus complicating a triplet pregnancy: management and outcome.

Objective: To report our experience with the management of triplet pregnancies complicated by an acardiac fetus.

Methods: During the 5-year period from 2003 to 2008, five cases were identified. The prenatal sonographic findings, antepartum course, antenatal intervention if performed, and perinatal outcome of each case were reviewed.

Congenital diaphragmatic hernia in a first-trimester ultrasound aneuploidy screening program.

Objectives: To review our experience with the prenatal detection of congenital diaphragmatic hernia (CDH) in fetuses presenting for ultrasound screening of chromosomal abnormalities in the first trimester.

Methods: As part of our first-trimester ultrasound protocol, fetuses with a crown-rump length between 45 and 84 mm underwent a limited anatomical assessment in conjunction with nuchal translucency thickness measurement and nasal bone assessment. Cases of CDH diagnosed prenatally or after delivery in this population were identified.

Three-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord: value and limitations.

Objective: The purpose of this study was to examine the value of 3-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord.

Methods: Cases in which the diagnosis of a true knot of the umbilical cord was suspected by prenatal 2-dimensional sonography were reviewed. The presumably affected segment of the cord was examined with 3-dimensional power Doppler sonography for further characterization.

Endoscopic laser surgery in severe second-trimester twin-twin transfusion syndrome: a three-year experience from a Latin American center.

Objective: In order to assess the outcome of pregnancies complicated by severe second trimester twin-twin transfusion syndrome (TTTS) undergoing treatment with endoscopic laser surgery, we reviewed our experience following the implementation of an institutional fetal surgery program.

Methods: Patients presenting with monochorionic-diamniotic twin pregnancies complicated by severe TTTS before 26 weeks of gestation were offered endoscopic laser surgery to coagulate placental vascular anastomoses. Using regional anesthesia and guided by real-time sonography, anastomoses were identified and selectively coagulated.

Minilaparotomy hysterectomy assisted by self-retaining elastic abdominal retractor.

Study Objective: To verify the efficacy and safety of minilaparotomy hysterectomy using a self-retaining elastic abdominal retractor.

Design: Retrospective study (Canadian Task Force classification II-3).

Setting: Private hospital, department of obstetrics and gynecology.

Discordant lower urinary tract obstruction in early twin gestations: management and outcome.

Objective: To report our experience with the management of twin pregnancies discordant for lower urinary tract obstruction.

Methods: Cases of twin pregnancies discordant for lower urinary tract obstruction were identified from our fetal medicine database. Information on ultrasonographic findings, antenatal course, pregnancy complications, and perinatal outcome was obtained by reviewing medical records or contacting the referring obstetricians.

Perinatal outcome after prenatal diagnosis of placental chorioangioma.

Objective: To review the prenatal complications, management, and perinatal outcome in pregnancies complicated by placental chorioangioma.

Methods: Cases of placental chorioangioma diagnosed prenatally as part of a prospective, multicentric program for fetal diagnosis and therapy were identified. All cases were evaluated with color flow imaging.