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Vol. 18, No. 5, 2003
Issue release date: September–October 2003
Section title: Paper
Fetal Diagn Ther 2003;18:314–320
(DOI:10.1159/000071972)

Chorioamniotic Membrane Separation following Open Fetal Surgery: Pregnancy Outcome

Wilson R.D. · Johnson M.P. · Crombleholme T.M. · Flake A.W. · Hedrick H.L. · King M. · Howell L.J. · Adzick N.S.
Departments of Surgery and Obstetrics/Gynecology, Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa., USA

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Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 5/25/2002
Accepted: 8/27/2002
Published online: 8/15/2003

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 5

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

Abstract

Objective: To review the incidence of posthysterotomy chorioamniotic membrane separation and delivery outcome following open fetal surgery [myelomeningocele (MMC); cystic adenomatoid malformation (CCAM); congenital diaphragmatic hernia (CDH); sacrococcygeal teratoma (SCT)]. Study Design: Retrospective review of a maternal population undergoing open fetal surgery at a single tertiary level program (1998–2001) following the initiation of close postoperative ultrasound follow-up for membrane separation. Onset of membrane separation was coded as not present (NP), immediate (<2 weeks) or delayed (>2 weeks) from day of surgery. Results: Fifty-three charts were reviewed: MMC 43, CCAM 7, CDH 1, and SCT 2. In the MMC group there were 26 NP, 8 immediate, and 9 delayed. Preterm labor occurred in 4 patients with only 2 having had membrane separation. Risk of membrane separation is increased for surgery done at less than 23 weeks gestation (p < 0.005). Delay from MMC surgery to delivery was 11.0, 9.8, 12.0 weeks for NP, immediate, and delay, respectively. In the MMC group, there were 3 neonatal deaths (NND) at 9, 9, and 21 days post surgery (PROM/PTL; chorioamnionitis, PROM/PTL, respectively). No membrane separation was present in the CCAM, CDH, and SCT cases. Conclusions: (1) Membrane separation was significantly more likely to occur if surgery was performed prior to 23 weeks. (2) Membrane separation post hysterotomy (17/50 = 34%) may be associated with an increased risk of PROM but not delivery before 30 weeks gestation. (3) Delivery prior to 33 weeks gestation for MMC groups was 12/43 (28%) with 3 NND (7%). (4) Elective delivery at 36–37 weeks gestation was possible for 43% of the fetal surgery population.


Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 5/25/2002
Accepted: 8/27/2002
Published online: 8/15/2003

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 5

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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