By Sailesh Kumar

"Handbook of Fetal medication presents a concise and useful advisor to the fashionable administration of standard being pregnant and the at-risk fetus. finished in scope, in an easy-to-use layout, the ebook offers tips on quite a lot of stipulations, most sensible perform administration techniques and cures in maternal-fetal drugs. every one system-based bankruptcy has a quick advent on embryology and discusses the key Read more...

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In these cases survival may be improved from 10% to 40%–50% after fetal treatment. • Management of cases must include detailed assessment of the fetus for additional anomalies. Karyotyping and fetal echocardiography should be performed. • Fetal MRI or 3D ultrasound should be considered to evaluate lung volume. Parents should be counseled by a pediatric surgeon regarding neonatal management. • Termination of pregnancy is an option if significant visceral herniation (particularly liver) and early diagnosis.

Mode of delivery is made on standard obstetric grounds. Essential that delivery takes place in tertiary centre. • Postdelivery, the baby will need close monitoring to assess degree of pulmonary compromise (hypoplasia and vascular hypertension) before surgery is undertaken. • In selected cases inhaled nitric oxide or the use of prostacyclin may be of benefit if pulmonary hypertension is problematic. • Primary closure of the diaphragm is possible if the defect is small, otherwise a synthetic mesh may be required.

Amniocentesis • One of the most commonly performed prenatal diagnostic procedures. Suitable for a variety of indications: karyotyping, detect evidence of intrauterine infection, evaluating fetal lung maturity (lecithin/ sphingomyelin ratio), etc. • Only active maternal HIV infection is an absolute contraindication to the procedure. • Generally performed beyond 15 weeks under continuous ultrasound guidance (Fig. 1). Amniocentesis performed before 15 completed weeks of gestation is referred to as early.

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