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dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
Fetal Therapy: Options and Medical                            Treatment  Pacemakers In the past two decades,     the goal ...
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
IVT
Survival rate in Rh Isoimmunized Fetuses               dokter_nudi@yahoo.com /              nurwansyah.nudi@gmail.com
Survival for In-Vitro Transfused      Hydroponic Fetuses             dokter_nudi@yahoo.com /            nurwansyah.nudi@gm...
Pathophysiology of Transfusion                                       To calculate the                                     ...
Hydrocepha   l us
Fetal Obstructive Hydrocephalus: Distribution byPrimary Diagnosis and Survival in 41 Treated Cases                   dokte...
Fetal Obstructive Hydrocephalus: Outcome in 34            Treated Surviving Infants                 dokter_nudi@yahoo.com ...
Fetal Obstructive Hydrocephalus: Relationship of       Duration of Treatment to Outcome                  dokter_nudi@yahoo...
PleuralEffusions Hal 315 Tab             el   29.1, 29.2
Clinical Data Summary         dokter_nudi@yahoo.com /        nurwansyah.nudi@gmail.com
Prognostic Indicator       dokter_nudi@yahoo.com /      nurwansyah.nudi@gmail.com
Obstructive Uropathy
Antenatal Sonographic Features of Fetuses       with Urethral Obstruction               dokter_nudi@yahoo.com /           ...
Prognostic Criteria for The Fetus with Bilateral            Obstructive Uropathy                       dokter_nudi@yahoo.c...
Management                            scheme for the                            fetus with bilateral                      ...
dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
Surgical InterventionsThree approaches are currently used forinvasiveA.Ultrasonography-guided vesicoamnioticand, less comm...
B.   Fetoscopic techniques now have a     clinical application in the ligation of     umbilical cords in acardiac twins, i...
1.     The procedure is performed              inside the uterus using          endoscopes, with a much     smaller hyster...
2.   The success of the procedure depends      on the use of both a transabdominal     ultrasonographic intraoperative vie...
3.    The drawbacks of fetoscopic surgery     are the risk of bleeding (avoiding the       transplacental route decreases ...
C.   Open fetal surgery is currently     performed at select centers in     instances in which the risk of the     procedu...
Monitoring During Surgery    The parameters monitored during and after surgery    include the following:    •Myometrial co...
Monitoring During Surgery       •   Ultrasonographic findings in           cases of fetoscopic surgery       •   Fetal tem...
These surgical techniques are consideredappropriate for 9 lesions.         1.   Obstructive uropathy         2.   Hydrocep...
AuthorExperiences“In Indones              ia”
NO   Author        Procedure                      D/                 Outcome1.   Nurwansyah,   Cephalocentesis            ...
NO   Author        Procedure                 D/                   Outcome7,   Nurwansyah,   Amnioinfusion             Rena...
Terima Kasih   dokter_nudi@yahoo.com /  nurwansyah.nudi@gmail.com
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Fetal therapy indonesian experiences

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Fetal therapy indonesian experiences

  1. 1. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  2. 2. Fetal Therapy: Options and Medical Treatment Pacemakers In the past two decades, the goal of prenatal diagnosis has changed from merely deciding aboutterminating the pregnancy to possible active intervention for improving the long-term outcome of the fetus. Recently, medical and surgical fetal therapy has emerged as an option for the management of various fetal malformations. dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  3. 3. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  4. 4. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  5. 5. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  6. 6. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  7. 7. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  8. 8. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  9. 9. IVT
  10. 10. Survival rate in Rh Isoimmunized Fetuses dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  11. 11. Survival for In-Vitro Transfused Hydroponic Fetuses dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  12. 12. Pathophysiology of Transfusion To calculate the volume of donor blood necessary to achieve a post- tranfusion fetal hematocrit of 40%, the estimated fwtoplacental blood volume (left, e.g., 100mL at 27 weeks) is multiplied by DF (right, e.g., 0,8 for a pretransfusion fetal hematocrit of 10% and a donor hematocrit of 80%). dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  13. 13. Hydrocepha l us
  14. 14. Fetal Obstructive Hydrocephalus: Distribution byPrimary Diagnosis and Survival in 41 Treated Cases dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  15. 15. Fetal Obstructive Hydrocephalus: Outcome in 34 Treated Surviving Infants dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  16. 16. Fetal Obstructive Hydrocephalus: Relationship of Duration of Treatment to Outcome dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  17. 17. PleuralEffusions Hal 315 Tab el 29.1, 29.2
  18. 18. Clinical Data Summary dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  19. 19. Prognostic Indicator dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  20. 20. Obstructive Uropathy
  21. 21. Antenatal Sonographic Features of Fetuses with Urethral Obstruction dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  22. 22. Prognostic Criteria for The Fetus with Bilateral Obstructive Uropathy dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  23. 23. Management scheme for the fetus with bilateral hydronephrosis. Note that the development of prognostic criteria based on the assessment of fetal renal function allows improved counseling and management. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  24. 24. dokter_nudi@yahoo.com /nurwansyah.nudi@gmail.com
  25. 25. Surgical InterventionsThree approaches are currently used forinvasiveA.Ultrasonography-guided vesicoamnioticand, less commonly, thoracoamniotic shuntplacement, is used in a fetus from 16 weeksgestation to when lung maturity makespostnatal treatment the best option.Complications are inadequate function, dokter_nudi@yahoo.com /migration, and iatrogenic gastroschisis. nurwansyah.nudi@gmail.com
  26. 26. B. Fetoscopic techniques now have a clinical application in the ligation of umbilical cords in acardiac twins, in selective laser photocoagulation of communicating vessels in twin-to- twin transfusions, and in the ablation of posterior urethral valves. dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  27. 27. 1. The procedure is performed inside the uterus using endoscopes, with a much smaller hysterotomy than that needed for open procedures. This lessens the risks of preterm labor and fetal hypothermia and improves fetal hemostasis during the dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com procedure
  28. 28. 2. The success of the procedure depends on the use of both a transabdominal ultrasonographic intraoperative view and a simultaneous endoscopic view to guide placement of the trocars and cannulae. dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  29. 29. 3. The drawbacks of fetoscopic surgery are the risk of bleeding (avoiding the transplacental route decreases this risk), rupture of membranes, and chorioamnionitis. Fetoscopy may also be difficult because of poor access to the fetus due to fetal position or polyhydramnios. dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  30. 30. C. Open fetal surgery is currently performed at select centers in instances in which the risk of the procedure to the mother and fetus is overridden by a diagnosis with a known poor outcome. Complications such as chorioamnionitis, preterm labor, bleeding, and direct trauma to the fetus are risks in most of these procedures. dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  31. 31. Monitoring During Surgery The parameters monitored during and after surgery include the following: •Myometrial contractions and intrauterine pressures. • Maternal blood pressure, ECG, and pulse oximetric and blood gas levels. • Fetal pulse oximetric measurement (50%-60% saturation), heart rate, blood gases, and ECG dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  32. 32. Monitoring During Surgery • Ultrasonographic findings in cases of fetoscopic surgery • Fetal temperature (Maintain temperature with continuous warm sodium chloride irrigation, minimized exposure, and increased ambient temperature.) dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  33. 33. These surgical techniques are consideredappropriate for 9 lesions. 1. Obstructive uropathy 2. Hydrocephalus 3. Pleural effusion 4. Twin-To-Twin Transfusion syndrome 5. Amniotic band syndrome 6. Congenital Diaphragmatic Hernia 7. Congenital high airway obstruction syndrome 8. Sacrococcygeal teratoma. 9. Congenital Cystic Adenomatoid Maformartions dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  34. 34. AuthorExperiences“In Indones ia”
  35. 35. NO Author Procedure D/ Outcome1. Nurwansyah, Cephalocentesis Hydrocephaly Harapan Kita Gatot AR hospital2. Nurwansyah, Serial Vesicosentesis PUV Harapan Kita Gatot AR Hospital3. Nurwansyah, Thoracocentesis Isolated Harapan Kita Gatot AR hydrothorax Hospital4. Nurwansyah, Paracentesis Isolated Ascites Harapan Kita Gatot AR Hospital5. Nurwansyah, Amniotic-septostomi TTTS YPK Hospital Trijatmo R.6. Nurwansyah, IUT Hydropsfoetalis Harapan Kita Gatot AR ec Rh Hospital Incompatibility dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  36. 36. NO Author Procedure D/ Outcome7, Nurwansyah, Amnioinfusion Renal Agenesis bil ASIH Ari Waluyo Maternity Hospital8. Nurwansyah, IUT Hydrops foetalis ASIH Ari Waluyo, ec. ABO Maternity Indriani Incomptblt Hospital9. Nurwansyah, IUT Hydrops foetalis / BWCH Uf Bagasi Thallasemia dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com
  37. 37. Terima Kasih dokter_nudi@yahoo.com / nurwansyah.nudi@gmail.com

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