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Fetal diagnosis and therapy (part 1)
David Baud, Lausanne
Tuesday, Jan. 22, 2019 · 11:33 a.m. · 17m 07s
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sex was uh in addition to this meeting and so we share as a as
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a first position with a colour would present a impressive work they are doing
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a two week uh regarding the n. n. c. n. will
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more focus uh on the laser therapy for trains
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real uh see in a few minutes but for us before to begin
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with screens i would like to travel a little bit envy
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cool all over the world to go to a place that is exactly opposite to to this
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person and which is cora than what we're not within the middle of the pacific
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this is a uh the uh actually better with many i'd and and one of these i'd and is
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cool tonight and i was really interested to go was there because it is an active volcano
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that is also a place where people are still living like that and i spent
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one week with these people are living in this house here in my
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yeah consumers amount and uh in this house here and i had the pleasure to met this guy
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who is the midwife in charge of all silent so this guy he's able
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to do preach deliveries he's rate offices in section is zero percent
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uh i think of a it's thousand inhabitants of the island so we go from village to village
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he don't know how to read you don't know how a two count
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but he has a an experience we strange because i it
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it seems is there is a lot of greens on the island and he
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manage to to to to see that there is really between
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us and the uh identical train unknown identical true
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i'm asking what is the reason uh for for these differences i oh it's
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on the what kind of went to the park and know that
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uh uh and uh in big activity it has the power to
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break the x. fantastic when you think about it because it's
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in in in in biology it's what happened have also apple basis about how to break the eggs
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uh if you play tennis you are more likely to have it rains more seriously
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yeah there is to it every different a way to do twins i so you have
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two of it at the beginning we stewed tomatoes ah you will have a it these days i
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could take a train all you can start with only one over in ah that will break
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not to uh because of the volcano in switzerland or maybe because of the tennis
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break in into x. uh i at some point and it depend
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uh uh when it break what will be is uh the the few not tonight i've outcome
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and this is it is it was eighty four where you start what is very important
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in our fields the quite any c. t. how many percent value how often
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and you have here on the left tobacco unique uh
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uh twins i'm in the right a mechanic screens
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and uh uh uh you probably know was that this type of prince yeah i'm much much more risky has i've
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been shown by uh i said here in nineteen ninety seven not where you see here's a marketing team
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uh uh of these uh twins uh between the monaco nick on the top
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and the back tourniquet trains and you see that the malt whisky period
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before the model granite twins is between fourteen and twenty two weeks
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so in in a clinic what do we do it's very important to identify
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it as is difference of trains a very early in the pregnancy
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uh and we do uh we we we categorise it uh between both uh type of twins
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a very already it has to be done it uh before the end of
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the first trimester otherwise as a sign we used to when the devices
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two different type of princes disappear so we have here the
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sign of a a that i'm that anyway this is
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a response and ah of both screens got that go between those two trains it's yeah is there is
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only one last and the uh one percent that mechanic printed you have what we call the design so i
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had to break a lot of x. to find this one what you see here a mechanic a egg
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so why it's wouldn't raise uh between fourteen and twenty two weeks of pregnancy is
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because as a reason drum corps between between transfusion syndrome that might work uh
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this is a present time where we put colour or inside of a cell and you can see that
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here you can for those of us so up up up and go to the other trends
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which means says x. postings are able to exchange fried bread uh
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decreed between each other and sometimes it's just kind of sure
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one of the training which is called the don't know we'll keep all also is that creed or the foot to
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the other one who is a recipe and then you can see here is that's the easiest screen is
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completely stack i inside the membrane between uh has a a large swimming pool to swim in
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uh well i you can also see a very large by the uh i'd probably uh uh uh heard that is quite that
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if you don't do anything uh uh when you use uses existing between the vision syndrome
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the risk of the s. is very high about ninety percent of the keys
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ten percent of their remote might remain alive but most of them will have
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a cerebral palsy uh this is so cool of a a
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as a as a follow up during the pregnancy
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is to find any difference at any time between both
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to dislike what you have in the newspaper
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uh as it is kind of of of games where you have to find difference between
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for example the two cats so it's what we do drink was a pregnancy
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so we try to see if there is a difference of liquid if there is a difference in the size of data
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in the don't know our thoughts about uh is becoming absent if there is a difference in the doppler is about flows
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if didn't you want to be begin to to david i drops
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and of course the end stage of the country road stages
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is the death of front screen if you don't want to uh anything is a uh it was only made what you see one of the
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destruction here at the top of the utterance and the the reception three
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in assuming that very big uh who were and what we do
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working as a as a goal is to go inside is a tourist visa a very small canada
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to identify the the sense that go from one baby tutors user and to
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correlate is in uh in as a word is the goal is to
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to to to create with only one person to ah to law school are uh the person
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so for that we use a different uh scroll different material with different angle of vision
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uh is the easiest uh operation hopper from when the present that
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is pasta yeah because you are just on the present that
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that was all as as a fussing ask when i have four one uh uh when i
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have a quarter for for for two to refurbish an is what is a present that
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because when the person that is on pay or is more difficult to and uh inside the uterus
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and it's more difficult to operate because everything has to be a reverse
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to be able to to go on a uh this side of the person
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we do with these operation on the local anaesthesia and we also uh the uh
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maternal sedation not free for form on a lot more for the fit is
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uh because a remission tanya will go to the physicist loses a present that
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and uh a low was a fit this is not to move too much during the operation
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so this is the start of corporation you have to be sure that you you see a letter
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right thing go uh inside the uterine cavity you and the screws it can allow and it's
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what you will see it first and so you have to find a way to us who was a
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baby is to find a there's a present are you always and uh in the uh uh
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body you drum us a park uh if it was
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because you have much more place uh to work
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do you see here is a stock greens with the membrane here
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so if you can see the hand is completely stuck inside the membrane babies that it it anymore able to to to to move
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and this is an images of one of the and of the moses you have here is a membrane
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uh between both maybe just tuck screen is behind this membrane you have one vessels that go
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below the membrane it to make an honest to moses wheeze the reception to this so and you have a here
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typically nature of calculation of this is this'll how we do
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during these these are procedure
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so um when these techniques was developed he was deaf on uh between sixteen
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weeks between sixteen and twenty six weeks of registration um we have
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uh i make a study to see if they we still
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initiated week later when the the these are valuable
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of course if you have a baby is who is i dropped peak uh because of the twin to
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twin transfusion syndrome between twenty six and twenty eight weeks the chains of survival is very low
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so if we do a a surgery even uh as is uh at this
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late stage you might be a a continues the pregnancy a much longer
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and maybe the diva a six eight we play a later and uh
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search uh and so to improve the survival of the b. b.
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uh and we interface that we are yeah improves survival by twenty five percent
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and also to decrease the risk of verbal policy in z. is the uh treats
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these are the results we have uh as the same result as also part of the word
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so it's it's a slide whereas i i spend a lot of time with the
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parents 'cause they have to understand is not a hundred percent uh uh uh
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a procedure to uh i mean is is is is that the change to have
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two infant alive is around is the rounds is sixty to seventy percent
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the change to have at least one baby alive at the end of the prince he's eighty five percent
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and the risk of best of both strings is a
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around fifteen a person depending on the stage
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uh off the printer roll a disease as a ah the this is the
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stages all of the pregnancy um so this is a a side where
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i spend a lot of time with parents so they understand before the
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procedure that is not a hundred percent survival of the other children
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uh the next question of the parents when i show that is okay but
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what will be the long term outcome of our babies if this device
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and you see here several studies as it has been deaf on
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to and depending what's it called major a neurological amenities
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uh is is as as a rate a range between uh ten to eighteen percent uh is is a
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probably include a a lot of a different major not nor nor a juggler uh agreement is
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uh what we have seen it these experiences that is is this is not really do to that
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printed interjections oh syndrome is not really to to to to procedure uh that
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is performed is mainly due to the permit treaty of the babies
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because uh as as as as a risk of maturity is very high already because they are
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prince but also the surgery increase the risk of keep from uh for
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example or a delivery uh uh shortly after those those the passage
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uh we are a prude disciplinary team where we have our quite big
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uh i get ecologists we for the patient yeah i have
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a lot of quite take it inside the hospital uh to seizes patient eh we have to do
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it teams and is that these new metallurgy stupid obscure trees to for the vision janet east
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a regular just for enter i uh to to to to see
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the the part of the brain it uh the prince
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um because operate a lot uh in switzerland between the difference and uh
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uh i could elaborate mean me uh uh we we easily g. how you uh from the insertion silent
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and and we have a a a since two was thirteen when i came back from canada
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uh uh an experience uh a good experience to work together um
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there's a real question is how we work together and another word is there
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a what'd happen it is they're easy to admit all uh a vanity
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maybe goes was that uh in the next two sides all but when we met we make a review of
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the literature we put in the in the p. might push to cabin that there is a paper
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describing the difference how people in the german part of the french part of taking
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to the uh pet as you can see on these uh on the slide
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we speak to each other you will see in a few minutes uh eyes uh in english uh when we when we write
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uh on gem on on the phone and we operate in french so it's a beginning well a t.
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it is very good to have a a quite takes to to to discuss cases because
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uh be being to to discuss uh uh cases that we are much stronger
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we have also award network uh as to what substance houses whether that
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uh when we have difficulty cases we're not sure we go we don't go
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would we operate do do we not operate as there is always someone
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a wake on the world to to to to speak with and to
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have a a a a tips from i was uh uh sorry
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when he has on operation uh i go to to to to burn when i have
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an operation he come to less than and so we double our experience like that
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as i said at least speaking french rings operation is speaking german on
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the for one and we wrote which as a in english
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so uh we didn't well a team and the conclusion of our very
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strong research is that supposed to gavin between us do not exist
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i would like to send a sloppy homeowner who uh for all the devices
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to also is is operation in the in the sure even those and
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and this was the very first cases we operating to assert he next to where a triplets
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it's easiest to hear what doing uses it between between some should
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transcend syndrome and this was the guy who was a low
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who could have been a a a unique child but uh i into the we
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can get the and and he he's not a alone at home uh now
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um we can use easily that wrapped his four hours uh uh uh uh indication
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uh we have not done it's uh so far but it it's done the for example by how my father
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invest has pool for low urinary tract obstruction to to to to to burn
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the membrane and to liberate says was about uh some people have
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uh uh uh reduce edited bands with me is um uh in
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when i was in canada i we did some uh lays
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a fall a supple conceptual to rattle mark when there really is when the was eye drops a to the baby
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uh this is a case from lucerne and uh that was a refer to the to us was
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the was at twenty two weeks from remember when a very big cory was all mine nines
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intimate uh the uh the time it uh just use uh last last he'll the but still
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uh to from the baby and there's a baby was becoming i need can either pick
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and we uh uh managed to burn is a service centre
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here and this was a as a baby survivor well
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the recover from the eye drops and this was the korean drama at the end of the pregnancy baby is doing well
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also you can do that for poker parameter is the constructions was a baby
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at twenty two weeks a beginning to have a a significant eye drops
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uh uh we you also uses this technique to go
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and to burn the there's a feeding the seven
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so feeding myself i've uh was very close to see our to
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ah as you can see uh uh here and we managed
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uh_huh yep
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i got moving you know
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what i mean it's a serious i drop subsidy uh uh a result of that is a is a is a
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and to to a completely shrink it and this is a
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baby uh doing perfectly now and uh well now
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we have two cents or just one saw for our research and it's
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i would not say that as adopt all you have to go to to to see what to
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what we do to feel what the patient leave but uh i would like also to say next to sex might
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Fetal diagnosis and therapy (part 1)
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Fetal diagnosis and therapy (part 2)
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