Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta-analysis

OBJECTIVE: To establish maternal complication rates for fetoscopic or open fetal surgery. METHODS: We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery and after the index pregnancy. RESULTS: One hundred and sixty-six studies were included, reporting outcomes for open fetal (n=1193 patients) and fetoscopic surgery (n=9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI 15.22-27.13) for open fetal and 6.2% (95%CI 4.93-7.49) for fetoscopic surgery. For severe maternal complications (Grade III to V Clavien-Dindo classification of surgical complications) the risk was 4.5% (95%CI 3.24-5.98) for open fetal and 1.7% (95%CI 1.19-2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n=175, 23.3%) were excluded for failing to report the presence or absence of maternal complications. CONCLUSIONS: Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies

Diagnosis of Fetal Central Nervous System Anomalies by Ultrasonography

During the last 30 years, one of the most important instruments in diagnosis is ultrasonograph. It has an indispensible place in obstetrics. Its it possible to evaluate normal fetal anatomy, to follow-up fetal growth and to diagnose fetal congenital anomalies by ultrasonography. Central nervous system anomalies is the one of the most commonly seen and the best time for screening is between 18- and 22-week of pregnancy. In this paper, it is presented the sonographic features of some outstanding Central Nervous System anomalies. [Archives Medical Review Journal 2003; 12(2.000): 77-89

An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients

PubMedID: 22783989Problem: The aim of this study was to evaluate serum procalcitonin (PCT), C-reactive protein (CRP), and plasma D-Dimer levels in mild and severe pre-eclampsia. Method of study: Serum PCT, CRP, and D-Dimer levels were analyzed in 64 cases with pre-eclampsia as the study group and 33 healthy pregnant women in the third trimester as the control group. Pre-eclamptic group consisted of mild (n = 31) and severe pre-eclamptic subgroup (n = 33). Laboratory results were compared between the groups and diagnostic usefulness of these parameters were evaluated. Results: PCT, CRP, and D-Dimer levels were significantly higher in study group than the control group (P = 0.001). PCT, CRP, and D-Dimer were significantly higher in the patients with severe pre-eclampsia than mild pre-eclampsia. There were significant positive correlations between these markers and mean arterial pressure (MAP). Logistic regression analysis using the control and pre-eclampsia group showed that higher PCT (OR, 15.68; 95%-CI, 3.15-78.10), CRP (OR, 14.29; 95%-CI, 3.08-66.34), and D-Dimer levels (OR, 4.97; 95%-CI, 1.22-20.29) were found to be risk factors significantly associated with pre-eclampsia. Conclusions: This study results confirm that evidence of a possible exaggerated systemic inflammatory response in pre-eclampsia especially in severe pre-eclampsia. © 2012 John Wiley & Sons A/S