123 results match your criteria: "Center for Fetal Therapy[Affiliation]"

Objectives: Umbilical artery Doppler intermittent absent and reversed end-diastolic flow (iAREDF) is associated with increased perinatal morbidity and mortality in monochorionic twins with selective fetal growth restriction. The clinical significance of umbilical artery iAREDF in appropriately grown monochorionic twins is not well described.

Methods: This is a single-institution retrospective cohort study describing characteristics and outcomes of monochorionic diamniotic twins with appropriate for gestational age growth and umbilical artery iAREDF in comparison to monochorionic diamniotic twins with selective fetal growth restriction and iAREDF, or sFGR type III.

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The study aimed to develop structured, expert-based clinical guidance on the prenatal and postnatal management of hemolytic disease of the fetus and newborn. A Delphi procedure was conducted among an international panel of experts in fetal medicine, neonatology, and hematology. Experts were selected based on their expertise, relevant publications, and affiliations.

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Fetal Cortical Abnormalities Identified on Ultrasound.

Diagnostics (Basel)

October 2024

Department of Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Article Synopsis
  • - Normal neuronal cell differentiation and migration are essential for brain formation, particularly during fetal development, peaking around the time of routine ultrasound exams.
  • - Abnormalities in cortical migration may indicate genetic issues or fetal injury that could significantly affect the child's future development.
  • - The text discusses three cases where prenatal ultrasound was crucial in diagnosing fetal cortical abnormalities in the mid-trimester, aiding in timely clinical counseling.
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Intrauterine transfusion (IUT) of the donor and partial exchange (pET) of the recipient is a temporizing treatment for pregnancies with Twin Anemia Polycythemia Sequence (TAPS). We aimed to provide a detailed description of the procedural approach and outcomes for sequential donor IUT and recipient pET in TAPS. Retrospective study of spontaneous TAPS referred to the Johns Hopkins Center for Fetal Therapy treated with donor IUT followed by recipient pET utilizing a double-syringe setup.

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Introduction: Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy carries a risk of death of the smaller twin, with a high risk of co-twin demise (40%) or co-twin neurological sequelae (30%). On the other, early delivery to prevent the death of the smaller twin may expose the larger twin to prematurity, with the associated risks of long-term physical, emotional and financial costs from neurodisability, such as cerebral palsy.

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This review describes an in-depth analysis of the neurotoxicity associated with the anesthetic agents used during fetal surgery, intending to highlight the importance of understanding the effects of general anesthetics on the developing brain, particularly in the context of open fetal surgery, where high doses are applied to facilitate surgical access and augment uterine relaxation. We examined evidence from preclinical studies in rodents and primates, along with studies in human subjects, with the results collectively suggesting that general anesthetics can disrupt brain development and lead to long-lasting neurological deficits. Our review underscores the clinical implications of these findings, indicating an association between extensive anesthetic exposure in early life and subsequent cognitive deficits.

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Bilateral renal agenesis (BRA) is a fetal anomaly which leads to anhydramnios and resultant pulmonary hypoplasia. Historically, this anomaly was universally fatal early in the neonatal period due to the severity of the associated lung disease. Over the last 30 years, innovations in fetal therapies-specifically, serial amnioinfusions-have led to instances of infant pulmonary survival and initiation of postnatal dialysis, raising the possibility that early neonatal death may not be inevitable.

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Introduction: The optimal protocol for serial amnioinfusions to maintain amniotic fluid in pregnancies with early-onset fetal renal anhydramnios before 22 weeks is not known. We compared the performance of two different approaches.

Methods: A secondary analysis was conducted of serial amnioinfusions performed by a single center during the external pilot and feasibility phases of the Renal Anhydramnios Fetal Therapy (RAFT) trial.

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In congenital diaphragmatic hernia (CDH), abdominal organs are displaced into the chest, compress the lungs, and cause mediastinal shift. This contributes to development of pulmonary hypoplasia and hypertension, which is the primary determinant of morbidity and mortality for affected newborns. The severity is determined using prenatal imaging as early as the first trimester and is related to the laterality of the defect, extent of lung compression, and degree of liver herniation.

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The role of fetal therapy in the management of mirror syndrome: a narrative review.

J Matern Fetal Neonatal Med

December 2024

Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA.

Objectives: Mirror syndrome (MS) is a condition characterized by the presence of maternal, fetal, and placental edema and is reversible through delivery or pregnancy termination. As fetal hydrops itself may be amenable to treatment, we sought to determine outcomes for MS primarily managed by fetal therapy through a narrative review of the literature and cases managed at our fetal center.

Study Design: PubMed, Embase, Web of Science, Scopus, and Google Scholar databases were searched through January 2024 using key words: mirror syndrome, Ballantyne's syndrome, fetal hydrops, maternal hydrops, pseudotoxemia, triple edema, maternal recovery, fetal therapy, and resolution.

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The Renal Anhydramnios Fetal Therapy (RAFT) trial is a study of serial amnioinfusions to prevent lethal neonatal pulmonary hypoplasia from early renal anhydramnios. Infant neurologic outcomes were not originally evaluated. We describe the high incidence of stroke observed among infants in the treatment arm of the trial at our center.

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Background: We compared early neurodevelopmental morbidity in young children with severe CDH who underwent FETO to those without fetal therapy.

Methods: We conducted a prospective study of severe CDH patients undergoing FETO (n = 18) at a single North American center from 2015 to 2021 (NCT02710968). Outpatient survivors (n = 12) were evaluated by a multidisciplinary team and compared to expectantly managed CDH patients.

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Article Synopsis
  • The study aimed to assess survival rates of twins with twin-to-twin transfusion syndrome (TTTS) after receiving Solomon laser treatment, categorized by Quintero stages.
  • Out of 402 pregnancies treated, 75.4% had both twins alive at discharge, with varying survival rates across Quintero stages, and donor twins had lower survival compared to recipients, especially in Stage III.
  • Significant risk factors for donor twin demise included higher intertwin size discordance and abnormal umbilical artery blood flow, with donor survival rates decreasing with greater size differences and absent or reversed blood flow.
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Article Synopsis
  • Recent studies have found microplastics in human blood and placenta, but their health effects are not fully understood.
  • In experiments with pregnant mice, exposure to polystyrene microplastics led to fetal growth restriction, prompting further research on polyethylene, a common type of microplastic.
  • The study showed that while polyethylene exposure did not affect fetal growth, it significantly increased blood flow in the umbilical artery, indicating potential risks to placental function and adverse pregnancy outcomes.
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Fetoscopic Endoluminal Tracheal Occlusion for Severe, Left-Sided Congenital Diaphragmatic Hernia: The North American Fetal Therapy Network Fetoscopic Endoluminal Tracheal Occlusion Consortium Experience.

Obstet Gynecol

March 2024

Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Medicine, UTHealth Houston, the University of Texas McGovern Medical School, and the Fetal Center at Children's Memorial Hermann Hospital, and the Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Texas Children's Hospital Fetal Center, Baylor College of Medicine, Houston, Texas; the Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland; The Richard Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; the Center for Fetal, Cellular & Molecular Therapy, Cincinnati Fetal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; the Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado; the Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota; the Fetal Care Center Dallas, Dallas, Texas; and the Fetal Treatment Center, University of California, San Francisco, San Francisco, California.

Objective: To report the outcomes of fetoscopic endoluminal tracheal occlusion in a multicenter North American cohort of patients with isolated, left-sided congenital diaphragmatic hernia (CDH) and to compare neonatal mortality and morbidity in patients with severe left-sided congenital diaphragmatic hernia who underwent fetoscopic endoluminal tracheal occlusion with those expectantly managed.

Methods: We analyzed data from 10 centers in the NAFTNet (North American Fetal Therapy Network) FETO (Fetoscopic Endoluminal Tracheal Occlusion) Consortium registry, collected between November 1, 2008, and December 31, 2020. In addition to reporting procedure-related surgical outcomes of fetoscopic endoluminal tracheal occlusion, we performed a comparative analysis of fetoscopic endoluminal tracheal occlusion compared with contemporaneous expectantly managed patients.

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Importance: Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival.

Objective: To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia.

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Maternal exposure to polystyrene nanoplastics alters fetal brain metabolism in mice.

Metabolomics

November 2023

Department of Chemistry, Memorial University of Newfoundland, Arctic Avenue St. John's, St. John's, Newfoundland, NL, A1C 5S7, Canada.

Article Synopsis
  • The study investigates how exposure to polystyrene nanoplastics in pregnant mice affects fetal brain metabolism, particularly during gestation and lactation.
  • Pregnant mice were given drinking water containing nanoplastics and researchers found significant decreases in important metabolites like GABA, creatine, and glucose in the fetal brain.
  • The findings suggest that maternal nanoplastic exposure disrupts normal brain development in fetuses, highlighting potential risks for human pregnancies and the need for further research.
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Background: Intrauterine transfusion (IUT) is an invasive but critical and potentially life-saving intervention for severe fetal anemia with demonstrated improvement in outcomes. The fetus is vulnerable to hemodynamic alterations and transfusion-related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences.

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Background: Findings from randomized trials (RCTs) on cervical pessary treatment to prevent spontaneous preterm birth are inconsistent.

Objectives: Our hypothesis suggests that adhering to the European Medical Device Regulation (MDR) and following the instructions for use are essential prerequisites for successful therapy. Conversely, the non-adherence to these guidelines will probably contribute to its failure.

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