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Fetal diagnosis and therapy (part 2)
Nicole Ochsenbein-Kölble, Zurich
Tuesday, Jan. 22, 2019 · 11:51 a.m. · 11m 46s
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so thank you very much for the introduction sell at the beginning i just
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want to remind you that and she to spend a beefy dot
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develops very early between day twenty and twenty four
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uh of uh the life of the embryo and what happens is that at that
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typically at the lower part of the spinal cord it gets not closed
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so uh when the women knows she's pregnant normally to defeat is already there
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actually i just overview um a scheme of a healthy back
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and a typical findings often n. c. with with that it's
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just exactly uh and a spinal cord on top
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and how do we diagnose on m. m. c. by ultrasound
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um meanwhile it's possible to diagnose it already only i hear you see pictures around twenty weeks
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and a healthy back with a naive are spinal cord typically it
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ends at a l. two threes so um it's it
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nicely here we can count from below or even from the top down there but but we know where we had
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and it it goes either sound findings artistic as structure and in here you
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know i think the the spinal cord um any knock on top
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to because other uh findings are um the banana sign the
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serb along which looks like a banana a lemon sign
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just call it struck a structure which reminds um on on lemon
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two hundred calls could be increased or even not
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and typically we think the hind brain here nation you nearly don't see
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the sarah bottom it's not up there where it should be
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and then that the typical findings on on the first or if you
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see a crater then it's uh could be a minus keith this
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so the question we typically have to ask what's exactly which
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type of um spinal if we don't do we see
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normally we speak from an last say it's an m. m. c. but to be honest there's some differences i
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quickly show you that so if we see a ah hind brain had nation and that's just exactly
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easily eight an m. m. c. you see there's a spinal cord ending up on top of this is
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if we have to greater you typically don't see it kind of ceased it uh
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but you it's important that you're sure that the spinal cord is still on tall
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uh and if you have a hibernation it's uh my dusty this
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if you don't have a hibernation but you see cystic sec
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then it could be and then sissy i might add this to seal cell are typically
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the central camel is kind of dilated so you see typically assist in assist
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and if you just see us tank and the spinal cord
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ease where you expect it it's in meaning gaussian
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so i'll answer it at our centre we offer a oh a prenatal diagnosis within twenty four hours
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m. or i i just found on isn't easy is and prenatal cancelling
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the question all these various the level of deletion very important for cancelling
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sell but by doing ultrasound we look at this by remote typically this
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is that nicely have these fine with that we're in now
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this is an overview on top so this is a typical scheme of a normal spam
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we look at spinal abnormalities as well so if we see a speed court arm
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it which is are not very good for the problem is is that um
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we have to diagnose so but i still mad to me or if we
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see some fluids built filled space is uh within the spinal cord
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we have a tsunami only so we check some different things as well
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you nicely c. d.'s fields cyst here um in this video
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you should say or ask you lots of diagnosis in this
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case i have prepared for cases um for you so
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you see here the brain the bunch recalls seem to be a little bit increase more than ten millimetres is
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our ten minutes is cut off then the question is to use the hibernation yes or no
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and i have this taste so which kind of spend if it out which you diagnose
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another picture
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which should help to find the correct diagnosis sell to conclude
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we haven't seen a hibernation the button uh the
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server won't look really nice we had the fluid fill fill space behind and you see the system deceased
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so this last um yellow says to seal and if a level of
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deletion was at four five the next you see these uh
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nice spinal cord we count from up to down from about what it ends up here
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so the sacraments me think this was a case of a cotton regression syndrome
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so if you look at all our for rules we always have to be sure that we see the spectrum
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the third case
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the band recalls here prominent the question is hibernation yeah for now and here the opens
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fine and then you see the great that this is the power cord going or
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here on pot and i'll see what the exact
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diagnosis in this case it's definitely yeah hibernation
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these are the interpretive pictures and just to show you how are sometimes
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easy it is to see what it is but sometimes very difficult
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we can con from down up our um for buff and hear clearly the spinal cord is open but uh
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um if the opening and you just introverted to this was that
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ah i just keep this added to the last k. s.
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um what would you say is it that hibernation yeah yeah nation here
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yes or no and where is the level of deletion so um
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in this case um if we count here is um l. one two three four five
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this is them arrive with the finding is about the interrupt if
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i'm picture this was a m. m. c. l. five
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well what are the options uh if we diagnose an m. m. c.
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i mean you can do and post up a post um naval operation this was the
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case two thousand fourteen you see how it looks like um if you diagnose it
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early enough for a few collaboration you can offer maybe
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futile operation if them more than a few disqualifies
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or termination if you early enough nowadays if we diagnose it early enough
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um there's evidence that's to feed is definitely if that uh benefits
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from the feed liberation but if not what do we expect
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uh over ninety percent of the features us develop a high tourist office message interview chair their incontinent
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defeat the uh operation works in a three layer closure
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so this is a this team i already said uh showed you and now i was a show quick
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if you picture is it to get an impression how it works in zurich with our teen
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here you see the the opening of tutors with the state
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law it has the advantage that it does not lead
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we can operate easily our our um television
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um so here you see the spinal
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cord or a little bit of michael young and excise uh the skin
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and here you wait closure closures um the spinal cord and at the end
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if you have done this relay or closure it looks like that
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at the at the address as to be closed as well and
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and uh to lay system um and then nearly operation exchange
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if you uh i'll show you of all on our data meanwhile we have operated hundred and three
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patients already so uh one fourth of the patients come from system and the rest from
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other countries mainly from uh germany and austria
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these are the results on because they shut h. so we're
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quite proud uh we reach the medium thirty six weeks
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um over eighty percent of all patients and up above thirty
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four weeks with a good a good station and wait
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and nicely hit screens and movements of the lakes but we have to be sure it's a big operation for the
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mothers i quickly give you know will view on uh
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the complications we had ten percent percent of options
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uh we had lock all patients normally come back at thirty four weeks that we can manage them
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um we had a few patients who stayed at the hospital because of contractions because of
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membranes problems and we all could manage them answer it without any further harm to the mother and the features
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are we had um bonn altering rapture um just the day before we plan to
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see section at thirty seven days so um id and everything went about
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and but we had three percent off long embolism in our
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patients to patients on the third day after depression
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wait a minute shower everything went well and one patient art was
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diagnosed during the c. section b. so the u. k. g.
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differences on the monitor and diagnosed on about this but one has
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to be sure they're definitely a side effects for the mother
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to the neurological out come over fifty percent profit i'm not
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that they have a level gain of one or even
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two levels or more i hear this the slides the data compared
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to the monster i which was the trial was proven
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shown that the um prenatal operation was better than the post natal
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operation just that you see a little bit the comparison
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another question all patients always ask us as a lot of functions these are
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the data we right now have so dependent on the age of the
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babies this is that the then the your your um of two
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round half the patients profit or content and which is of course i'm a quality of life
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and um i used opportunity to um mention our congress
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we're planning on 'em fee to madison standards
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i'm rowland managed to have a really uh interesting program
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if you have time you more than welcome
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a lot of let's say what charts will come um and if you still have
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time to be there after we have a nice meeting in sales um
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um it's to international feet limited um surgery
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society um and we we are
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the band performing the congress and it would be nice if you're
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interested to are the comments well thank you very much higher
Conference Program
Welcome words
Matthias ROTH-KLEINER and Philipp MEYER, resp. Lausanne and Aarau
Jan. 22, 2019 · 9:34 a.m.
384 views
Welcome words
Markus Hodel, Lucerne
Jan. 22, 2019 · 9:39 a.m.
137 views
Short report - Outcome of very preterm infants
Philip Thwaites, Zürich
Jan. 22, 2019 · 9:42 a.m.
477 views
Short report - Bronchopulmonary dysplasia (BPD)
Ikbel El Faleh, Lausanne
Jan. 22, 2019 · 9:50 a.m.
360 views
Short report - Evaluation of exposure to vancomycin in neonates with current dosing approaches
Kim Dao, Lausanne
Jan. 22, 2019 · 10:01 a.m.
353 views
Short report - Characterization of postnatal sodium fluctuations in very preterm neonates
Roland Gerull, Basel
Jan. 22, 2019 · 10:12 a.m.
Short report - Readiness for discharge in mothers of hospitalized neonates from a Swiss NICU: a study
Chloé Tenthorey, Lausanne
Jan. 22, 2019 · 10:24 a.m.
389 views
Fetal diagnosis and therapy (part 1)
David Baud, Lausanne
Jan. 22, 2019 · 11:33 a.m.
199 views
Fetal diagnosis and therapy (part 2)
Nicole Ochsenbein-Kölble, Zurich
Jan. 22, 2019 · 11:51 a.m.
368 views
Minimal invasive therapy of congenital malformations
S. Holland-Cunz, Basel
Jan. 22, 2019 · 12:03 p.m.
111 views
Discussion
Jan. 22, 2019 · 12:26 p.m.
118 views
Management of PPROM around 34 weeks (part 1)
R. Pfister, Geneva
Jan. 22, 2019 · 2:48 p.m.
Management of PPROM around 34 weeks (part 2)
B. Martinez de Tejada, Geneva
Jan. 22, 2019 · 3:06 p.m.
141 views
Late termination of pregnancy : legal, ethical and medical aspects
R. Favre, Strasbourg (France)
Jan. 22, 2019 · 3:58 p.m.
The beginning of life
T. Berger, Lucerne
Jan. 22, 2019 · 4:40 p.m.
480 views
Awards and Closing words
Jan. 22, 2019 · 5:04 p.m.
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