Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
CHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2t ot red blood cell (RBC) alloimmunization is arguably the quintessential success story in obstetrics. The pathophysiology is well described, the diagnosis is easily and reliably established and life-saving treatment for the fetus and newborn is available both in utero and after delivery with a high Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2 degree of success. Ultrasound has been used for diagnosis and as an adjunct for the treatment of RBC alloimmunization for several decades, and the apEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
plications for ultrasound are continuing to expand. This chapter will outline the current uses of ultrasound in the setting of the alloimmunized pregnCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2bin levels by spectrophotometry.1 The degree of change m the optical density at a wavelength of 450 mil (delta OD450) of light during spectr ophotometry of amniotic fluid correlates with the level of bilirubin in the fluid due to the preferential absorption of light at this wavelength by bilirubin. Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2High levels of bilirubin in amniotic fluid correlate with the severity of RBC alloimmunization and have been used to guide therapy. Beginning around 1Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
961, treatment for severe RBC alloimmunization consisted of either percutaneous intraperitoneal fetal transfusion (IPT) or early delivery.2 At that tiCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2luoroscopy, using radiation, to outline tire fetus and guide needle placement into the fetal abdominal cavity. Real-time ultrasound subsequently replaced amniography as the imaging study of choice.Real-time ultrasound allowed the development of percutaneous intravascular blood transfusion to the fet Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2us. This first occurred by fetoscopy and later by cordocentesis, also known as funipuncture or percutaneous umbilical blood sampling (PUBS). PUBS IS aEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
n ultrasound-guided procedure.5-4 Percutaneous umbilical blood sampling allows more accurate diagnosis of fetal anemia and the need for intrauterine tCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2of advances in image quality, intrauterine transfusion (IUT) can now lie performed in the early second trimester for the rare cases that present with severe fetal anemia very early in gestation.During the decade of the 1990s, the Collaborative Group for Doppler Assessment of the Blood Velocity in An Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2emic Fetuses studied numerous blood vessels in an effort to find a way to reliably diagnose severe fetal anemia (that would require invasive treatmentEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
). They were successful with the middle cerebral artery and their results were published in the year 2000.5 This has paved the way to a noninvasive meCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2s. (A) The left image is a transverse or axial image of the fetal chest showing bilateral large pleural effusions surrounding the fetal heart. The right Image IS a longitudinal or coronal scan of the fetal thorax (towards the right of the image) and abdomen (towards the left of the image) showing bi Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2lateral large pleural effusions above the diaphragm; (B) Axial scan of the fetal head in the same patient showing skin edema (arrows)fetal anemia, whiEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
ch has led to a decrease in morbidity from invasive procedures.DIAGNOSISThe identification of antibodies in maternal serum is the key to finding the aCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2is (Figs 30.1 A and B). Severe fetal anemia can lead to hydrops fetalis and this is probably produced by a combination of pathophysiologic factors, including hypoalbuminemia and hepatic damage from extramedullary hematopoiesis? The fetalTABLE 30.1Diagnosis of hydrops fetalis*•Polyhydramnios•Thickene Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2d placenta (> 6 cm)•Pericardial effusion•Ascites•Skin edema•Pleural effusion•Findings are listed in the order of usual progression of diseasehematocriEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
t is usually below 15% when hydrops is present. When immune hydrops fetalis is present, IUT is lifesaving, and usually needs to be performed within 1-CHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2gn of hydrops, particularly in the alloimmunized pregnancy.When fetal anemia becomes severe, there can also be changes in fetal behavior, due to tile restriction of oxygen delivery to fetal tissues. The fetus may then conserve energy by limiting its movements. The biophysical profile is an assessmen Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2t of the character and frequency of fetal movements along with an assessment of the volume of amniotic fluid. The biophysical profile can possibly ideEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
ntity- the fetus who is decompensating, but may not be reliable for this purpose. The biophysical profile does not distinguish between severe acidemiaCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2und IS commonly used to guide the diagnostic procedure of cordocentesis or PUBS (Figs 30.2A to C). First, ultrasound is used to identity- the umbilical cord insertion into the placenta, then a 20 or 22 gauge needle is placed percutaneously through the maternal abdomen into the fetal umbilical vein a Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2t the level of the placental cord insertion. An alternative site is the fetal intrahepatic portion of the umbilical vein, which may be chosen if the pEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
lacenta is posterior and the position of the fetus limits accessibility to the placental cord insertion site. Tire placental cord insertion is generalCHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2used as the access point to the umbilical vein because their mobility limits the success of puncture. The vein is chosen because it has a larger caliber and usually allows a shorter procedure time. It is also drought that puncture of an arterial vessel is more likely to produce fetal bradycardia.494 Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2 Section 2 / ObstetricsFigures 30.2A to C: Percutaneous umbilical blood sampling or cordoccntcsis tor intrauterine fetal transfusion. (A) Ultrasound iEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
mage of a needle being placed through the maternal abdominal wall and placenta into the umbilical vein at the placental cord insertion in a pregnancy CHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2 needle tip in the umbilical vein (color Doppler turned off)Noninvasive DiagnosisDuring tile past two decades many tetal vessels and morphologic findings have been evaluated for ultrasound or Doppler findings that would allow a specific diagnosis ot severe total anemia prior to the development of hy Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2drops fetalis. An excellent review ot this experience is available.5 rhe optimal lime for diagnosis of severe anemia is prior to the development ot hyEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
drops totalis because the mortality increases once hydrops has occurred/ A group ot investigators working consistently during I he decade of lhe 1990CHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2nographers consistently with technical accuracv.’'10"'1 I he viscositv ot blood is inversely correlated with the speed ot blood flow in vessels. Assuming the same pumping force is applied, the lower the viscosity of blood in vessels, the higher the velocity. When fetal anemia becomes severe, tire vi Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2scosity ot blood is markedly decreased, and this leads to a markedly increased peak systolic velocity'. The angle of incidence at which the ultrasoundEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
beam intersects the blood flowing in a vessel affects the results of many Doppler measurements. Due to this limitation, most Doppler indices include CHAPTERUltrasound in the Management of the Alloimmunized PregnancyDaniel w SkupskiDu© to th© advent ot ultrasound imaging, th© diagnosis and treatment Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2ty — the measurement of peak systolic-velocity of blood in a vessel requires that no angle collection be performed.10 With a 0° angle of incidence no angle correction is needed and the measurement of peak systolic velocity is then very' accurate.The Specific technique tor pci forming MCA-PSV measure Ebook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2ments includes magnifying the image on the screen, using color Doppler to visualize the middle cerebral artery of the fetus and adjusting the transducEbook Donald school textbook of ultrasound in obstetrics and gynecology (3rd edition): Part 2
er on the maternal abdomen so tliat the angle of incidence of the beam to the artery is 0", i.e. the direction of blood flow in the vessel should be aGọi ngay
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