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Der Fetus als Patient – Chirurgische und medikamentöse Therapie

  • Chapter
Die Geburtshilfe

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Zusammenfassung

Durch pränatalmedizinische Diagnostik werden zahlreiche Schwangere – meistens Monate vor dem errechneten Geburtstermin – mit dem Vorliegen lebensbedrohlicher oder die nachgeburtliche Lebensqualität ihrer Ungeborenen erheblich beeinträchtigender Erkrankungen konfrontiert. Diese Problematik hat über die letzten Jahrzehnte zahlreiche Wissenschaftler dazu inspiriert, chirurgische und medikamentöse Therapien zur Verbesserung der Prognose betroffener Ungeborener zu entwickeln. Während sich die chirurgischen Therapien noch größtenteils im Experimentalstadium befinden und nur an einzelnen Zentren durchgeführt werden, sind die medikamentösen Therapien aufgrund ihrer häufigeren Verwendung, ihrer weiten Verbreitung und ihres dokumentierten therapeutischen Vorteils schon nahezu als etablierte Verfahren anzusehen. Das Kapitel gibt eine kurze Übersicht über Indikationen, rationale und derzeitig durchgeführte vorgeburtliche Behandlungsmöglichkeiten.

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Literatur

  • Allan LD, Maxwell DJ, Carminati M, Tynan MJ (1995) Survival after fetal aortic balloon valvoplasty. Ultrasound Obstet Gynecol 5: 90–91

    Article  CAS  PubMed  Google Scholar 

  • Berg C, Geipel A, Kohl T, Breuer J, Germer U, Krapp M, Baschat AA, Hansmann M, Gembruch U (2005a) Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers. Ultrasound Obstet Gynecol 26: 4–15

    Article  CAS  Google Scholar 

  • Berg C, Geipel A, Kamil D, Knüppel M, Breuer J, Krapp M, Baschat A, Germer U, Hansmann M, Gembruch U (2005b) The syndrome of left isomerism: sonographic findings and outcome in prenatally diagnosed cases. J Ultrasound Med 24: 921–931

    Google Scholar 

  • Biard JM, Johnson MP, Carr MC, Wilson RD, Hedrick HL, Pavlock C, Adzick NS (2005) Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction.Obstet Gynecol 106: 503–508

    Article  PubMed  Google Scholar 

  • Bruner JP, Tulipan N (2004) Tell the truth about spina bifida. Ultrasound Obstet Gynecol 24: 595–596

    Article  CAS  PubMed  Google Scholar 

  • Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG (2005) Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 105: 239–245

    Article  PubMed  Google Scholar 

  • Clark TJ, Martin WL, Divakaran TG, Whittle MJ, Kilby MD, Khan KS (2003) Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and metaanalysis. Obstet Gynecol 102(2): 367–382

    Article  PubMed  Google Scholar 

  • Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R (2003) Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn 23:740–742

    Article  PubMed  Google Scholar 

  • Crombleholme TM, Dirkes K, Whitney TM, Alman B, Garmel S, Connelly RJ (1995) Amniotic band syndrome in fetal lambs I: Fetoscopic release and morphometric outcome. J Pediatr Surg 30: 974–978

    Article  CAS  PubMed  Google Scholar 

  • Danzer E, Finkel RS, Rintoul NE, Bebbington MW, Schwartz ES, Zarnow DM, Adzick NS, Johnson MP (2008) Reversal of hindbrain herniation after maternal-fetal surgery for myelomeningocele subsequently impacts on brain stem function. Neuropediatrics 39(6): 359–362

    Article  CAS  PubMed  Google Scholar 

  • Deprest J, Gratacos E, Nicolaides KH (2004) Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol 24: 121–126

    Article  CAS  PubMed  Google Scholar 

  • Duncombe GL, Dickinson JE (2001) Fetal thyrotoxicosis after maternal thyroidectomy. Aust NZ J Obstet Gynaecol 41: 224–227

    Article  CAS  Google Scholar 

  • Forest MG, David M, Morel Y (1993) Prenatal diagnosis and treatment of 21-hydroxylase deficiency. J Steroid Biochem Mol Biol 45: 75–82

    Article  CAS  PubMed  Google Scholar 

  • Friedman DM, Kim MY, Copel JA, Llanos C, Davis C, Buyon JP (2009) Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol 103(8): 1102–1106

    Article  PubMed Central  PubMed  Google Scholar 

  • Gembruch U, Geipel A (1999) Die indirekte und direkte medikamentöse Therapie des Fetus. Gynäkologe 32: 840–854

    Google Scholar 

  • Gembruch U, Somville T (1995) Intrauterine Diagnostik und Therapie fetaler Arrhythmien. Gynäkologe 28: 329–345

    CAS  PubMed  Google Scholar 

  • Gembruch U (2009) Fetal tachyarrhythmia. In: Yagel S, Silverman N, Gembruch U (eds) Fetal cardiology, (2nd ed). Informa Health Care, New York, pp 435–447

    Google Scholar 

  • Gorincour G, Bouvenot J, Mourot MG, Sonigo P, Chaumoitre K, Garel C, Guibaud L, Rypens F, Avni F, Cassart M, Maugey-Laulom B, Bourliere-Najean B, Brunelle F, Durand C, Eurin D (2005) Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume. Ultrasound Obstet Gynecol 26: 738–744

    Article  CAS  PubMed  Google Scholar 

  • Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O´Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD, Klein RZ (1999) Maternal thyroid defiency during pregancy and subsequent neurophysiological development of the child. N Engl J Med 341: 549–555

    Article  CAS  PubMed  Google Scholar 

  • Hatijs CG (1993) Diagnosis and successful treatment of fetal goitrous hyperthyreoidism caused by maternal Graves disease. Obstet Gynecol 81: 837–839

    Google Scholar 

  • Jani J, Keller RL, Benachi A, Nicolaides KH, Favre R, Gratacos E, Laudy J, Eisenberg V, Eggink A, Vaast P, Deprest J (2006) Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynecol 27: 18–22

    Article  CAS  PubMed  Google Scholar 

  • Jani JC, Nicolaides KH, Gratacos E, Valencia CM, Done E, Martinez JM, Gucciardo L, Cruz R, Deprest JA (2009) Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 34(4): 304–310

    Article  CAS  PubMed  Google Scholar 

  • Kilby M, Khan K, Morris K, Daniels J, Gray R, Magill L, Martin B, Thompson P, Alfirevic Z, Kenny S, Bower S, Sturgiss S, Anumba D, Mason G, Tydeman G, Soothill P, Brackley K, Loughna P, Cameron A, Kumar S, Bullen P (2007) PLUTO trial protocol: percutaneous shunting for lower urinary tract bstruction randomised controlled trial. Br J Obstet Gynaecol 114(7): 904–905, e1–4

    Google Scholar 

  • Kilian AL, Schaible T, Hofmann V, Brade J, Neff KW, Büsing KA (2009) Congenital diaphragmatic hernia: predictive value of MRI relative lung-to-head ratio compared with MRI fetal lung volume and sonographic lung-to-head ratio. 192(1): 153–158

    Google Scholar 

  • Kohl T (2002) Fetal echocardiography – New grounds to explore during fetal cardiac intervention. Pediatr Cardiol 23: 334–46

    Article  CAS  PubMed  Google Scholar 

  • Kohl T, McElhinney DB, Farrel J, Harrison MR, Scheld HH, Vogt J, Silverman NH (1998) Fetoplacental blood flow predicts outcome after open fetal surgery for diaphragmatic hernia in human fetuses. Pediatr Res 43: 23A

    Article  Google Scholar 

  • Kohl T, McElhinney DB, Farrel J, Scheld HH, Vogt J, Harrison MR, Silverman NH (1999) Impact of fetoscopic versus open fetal surgery on fetoplacental blood flow and outcome in human fetuses. European Heart Journal 20(Abstract Suppl): 644A

    Google Scholar 

  • Kohl T, Sharland G, Allan LD, Gembruch U, Chaoui R, Lopes LM, Zielinsky P, Huhta J, Vogt J, Scheld HH, Silverman NH (2000) World experience of fetal cardiac intervention in human fetuses with severe aortic valvar obstruction. Am J Cardiol 85: 1230–1233

    Article  CAS  PubMed  Google Scholar 

  • Kohl T, Hering R, Bauriedel G et al. (2005a) Percutaneous fetoscopic and ultrasound-guided decompression of the fetal trachea permits normalization of fetal hemodynamics in a human fetus with Fraser syndrome and congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia. Ultrasound Obstet Gynecol 27: 84–88

    Article  Google Scholar 

  • Kohl T, Müller A, Tchatcheva K, Achenbach S, Gembruch U (2005b) Fetal transesophageal echocardiography – Clinical introduction as a monitoring tool during fetal cardiac intervention in a human fetus. Ultrasound Obstet Gynecol 26: 780–785

    Google Scholar 

  • Kohl T, Gembruch U, Filsinger B, Hering H, Bruhn J, Tchatcheva K, Aryee S, Franz A, Heep A, Müller A, Bartmann P, Loff S, Hosie S, Neff W, Schaible S (2006) Early clinical experience with deliberately delayed temporary fetoscopic tracheal occlusion for the prenatal treatment of life-threatening right and left congenital diaphragmatic hernias. Fetal Diagn Ther 21: 314–318

    Google Scholar 

  • Kohl T (2008) Mending the tiniest hearts – an overview. In: Yagel S, Silverman N, Gembruch U (eds) Fetal cardiology, 2nd edn. Informa Health Care, New York

    Google Scholar 

  • Kohl T, Tchatcheva K, Merz W, Wartenberg HC, Heep A, Müller A, Franz A, Stressig R, Willinek W, Gembruch U (2009a) Percutaneous fetoscopic patch closure of spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical closure. Surg Endosc 23(4): 890–895

    Google Scholar 

  • Kohl T, Tchatcheva K, Weinbach J, Hering R, Kozlowski P, Stressig R, Gembruch U (2009b) Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans. Surg Endosc Jun 30 (Epub ahead of print)

    Google Scholar 

  • Kohl T (2010) Chronic intermittent materno-fetal hyperoxygenation in late gestation may improve on hypoplastic cardiovascular structures associated with cardiac malformations in human fetuses. Pediatr Cardiol 31(2): 250–263

    Article  PubMed Central  PubMed  Google Scholar 

  • Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U: Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 89: 913–917

    Google Scholar 

  • Lim FY, Crombleholme TM, Hedrick HL, Flake AW, Johnson MP, Howell LJ, Adzick NS (2003) Congenital High Airway Obstruction Syndrome: Natural History and Management. J Pediatr Surg 38:940–945

    Google Scholar 

  • Luks FI, Peers KH, Deprest JA, Lerut TE, Vandenberghe K (1999) The effect of open and endoscopic fetal surgery on uteroplacental oxygen delivery in the sheep. J Pediatr Surg 31: 310–314

    Article  Google Scholar 

  • Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, Toubert ME, Léger J, Boissinot C, Schlageter MH, Garel C, Tébeka B, Oury JF, Czernichow P, Polak M (2005) Management of Graves’ disease during pregancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 90: 6093–6098

    Google Scholar 

  • Marshall AC, Levine J, Morash D, Silva V, Lock JE, Benson CB, Wilkins-Haug LE, McElhinney DB, Tworetzky W (2008) Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn 28(11): 1023–1028

    Article  PubMed  Google Scholar 

  • MOMS-Trial [www.clinicaltrials.gov/ct2/show/NCT00060606?term= MOMS & rank=3]

  • Morreale de Escobar G, Obregón MJ, Escobar del Rey F (2004) Role of thyroid hormaone during early brain development. Eur J Endocrinol 151: U25–U37

    Google Scholar 

  • Nachum Z, Rakover Y, Weiner E, Shalev E (2003) Graves’ disease in pregancy: prospective evaluation of a selective invasive treatment protocol. Am J Obstet Gynecol 189: 159–165

    Article  PubMed  Google Scholar 

  • Peleg D, Cada S, Peleg A, Ben-Ami M (2002) The relationship between maternal serum thyroid-stimulating immunoglobulin and fetal and neonatal thyrotoxicosis. Obstet Gynecol 99: 1040–1043

    Article  PubMed  Google Scholar 

  • Perelman AH, Johnson RL, Clemons RD, Finberg HG, Clewell WH, Trujillo L (1990) Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism. J Clin Enocrinol Metab 71: 618–621

    Article  CAS  Google Scholar 

  • Poppe K, Glinoer D (2003) Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update 9: 149–161

    Google Scholar 

  • Quintero RA, Hume R, Smith C, Johnson MP, Cotton DB, Romero R, Evans MI (1995) Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynecol 172: 206–209

    Google Scholar 

  • Quintero RA, Morales WJ, Phillips J, Kalter CS, Angel JL (1997) In utero lysis of amniotic bands. Ultrasound Obstet Gynecol 10: 316–320

    Article  CAS  PubMed  Google Scholar 

  • Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M (1999) Staging of twin-twin transfusion syndrome. J Perinatol 19(8): 550–555

    Article  CAS  PubMed  Google Scholar 

  • Roberts D, Neilson JP, Kilby M, Gates S (2008) Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev 23(1): CD002073

    Google Scholar 

  • Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y (2004) Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome N Eng J Med 351: 136–144

    Google Scholar 

  • Singh PK, Parvin CA, Gronowski AM (2003) Establishment of reference intervals for markers of fetal thyroid status in amniotic fluid. J Clin Endocrinol Metab 88: 4175–4179

    Article  CAS  PubMed  Google Scholar 

  • Stressig R, Tchatcheva K, Van de Vondel P, Berg C, Geipel A, Gembruch U, Kohl T (2008) Fetoscopic surgery in amniotic band syndrome – A tale of two cases and conclusions drawn for fetal selection. Ultraschall Med 29: 120

    Google Scholar 

  • Stulberg RA, Davies GA (2000) Maternal thyrotoxicosis and fetal nonimmune hydrops. Obstet Gynecol 95: 1036

    Article  CAS  PubMed  Google Scholar 

  • Tubbs RS, Chambers MR, Smyth MD, Bartolucci AA, Bruner JP, Tulipan N, Oakes WJ (2003) Late gestational intrauterine myelomeningocele repair does not improve lower extremity function. PediatrNeurosurg 38: 128–132

    Google Scholar 

  • Tworetzky W, Wilkins-Haug L, Jennings RW, van der Velde ME, Marshall AC, Marx GR, Colan SD, Benson CB, Lock JE, Perry SB (2004) Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation 110: 2125–2131

    Google Scholar 

  • Walsh DS, Adzick NS, Sutton LN, Johnson MP (2001) The rationale for in utero repair of myelomeningocele. Fetal Diagn Ther 16:312–322

    Article  CAS  PubMed  Google Scholar 

  • Yanai N, Shveiky D (2004) Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol 23: 198–201

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Deutsches Zentrum für Fetalchirurgie und minimalinvasive Therapie (DZFT), Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, Bonn, 53105

    Prof. Dr. med T. Kohl

  2. Zentrum für Geburtshilfe und Frauenheilkunde Perinatalzentrum, Universitätsfrauenklinik Bonn, Sigmund-Freud-Straße 25, Bonn, 53105

    Prof. Dr. med. U. Gembruch

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  1. Prof. Dr. med T. Kohl
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  2. Prof. Dr. med. U. Gembruch
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Editors and Affiliations

  1. Univ.Klinikum Bern Frauenklinik, Bern, Schweiz

    Henning Schneider

  2. Klinische Abt. Geburtshilfe und Feto-maternale Medizin, Medizinische Universität Wien Universitätsklinik für Frauenheilkunde, Wien, Österreich

    Peter-Wolf Husslein

  3. Frauenklinik und Poliklinik Abt. Perinatalmedizin, TU München Klinikum Rechts der Isar, München, Deutschland

    Karl Theo Maria Schneider

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Kohl, T., Gembruch, U. (2011). Der Fetus als Patient – Chirurgische und medikamentöse Therapie. In: Schneider, H., Husslein, PW., Schneider, K. (eds) Die Geburtshilfe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-12974-2_26

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  • DOI: https://doi.org/10.1007/978-3-642-12974-2_26

  • Publisher Name: Springer, Berlin, Heidelberg

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