Conditions requiring Treatment in utero Flashcards
How do you accelerate lung maturation/ surfactant production?
Glucocorticoid via mother
How do you treat foetal SVT?
Digoxin or flecainide via mother
What are the complications of rhesus isoimmunisation?
Severely affected foetuses become anaemic and may develop hydrops
fetalis, with oedema and ascites
How do you detect and follow rhesus isoimmunisation?
Infants at inc risk are detecting by maternal antibody screening
Regular ultrasound of the fetus detects fetal anaemia noninvasively
using Doppler velocimetry of the fetal middle cerebral artery
How do you treat rhesus isoimunisation?
Fetal blood transfusion directly into the umbilical vein may be required
regularly in severely affected foetuses.
What has decreased the incidence of rhesus disease?
Incidence of rhesus haemolytic disease has fallen markedly since antiD immunisation of mothers began, but hydrops fetalis is still seen due
to other RBC antibodies, e.g. Kell
What is Perinatal Isoimmune Thrombocytopenia?
When anti-platelet antibodies from the mother cross the placenta and
cause thrombocytopenia in the foetus.
What are the consequences of Perinatal Isoimmune Thrombocytopenia?
Rare, but risk of intracranial haemorrhage secondary to
thrombocytopaenia
How do you treat Perinatal Isoimmune Thrombocytopenia?
Can be treated with IVIg and maternal glucocorticoid if high risk (e.g.
previously affected infant)
What foetal surgeries exist?
US guided Catheter shunt insertion
Laser ablation of placental anastomoses
Intrauterine Shunting
What is US guided Catheter shunt insertion?
To drain fetal pleural effusions (pleuro-amniotic shunts), often from a
chylothorax (lymphatic fluid) or congenital cystic adenomatous malformation
of the lung
What is Laser ablation of placental anastomoses?
Laser therapy to ablate placental anastomoses, which lead to the twin-twin transfusion
syndrome
What is Intrauterine Shunting?
Intrauterine shunting for obstruction to urinary outflow as with posterior urethral valves
What is pre-eclampsia?
Hypertensive syndrome occurring in pregnant women after 20 weeks’
gestation, consisting of new-onset, persistent hypertension with either proteinuria or
evidence of systemic involvement
What can Pre-eclampsia cause?
May require preterm delivery
Can cause maternal eclampsia (seizures in mothers with pre-eclampsia) or a cerebrovascular accident due to the high blood pressure
Associated with placental insufficiency and growth restriction
