An increasing number of fetal diseases are being detected prior to birth due to major improvements in prenatal ultrasound examinations and the wide implementation of screening programs. For various... Show moreAn increasing number of fetal diseases are being detected prior to birth due to major improvements in prenatal ultrasound examinations and the wide implementation of screening programs. For various diseases, fetal therapy may be a life-saving option or an alternative to postnatal treatment, to prevent permanent organ damage. A major breakthrough in fetal therapy was the introduction of intrauterine blood transfusion for severe fetal anemia in the early 1960s. Since then, fetal therapy has gradually evolved resulting in a dramatic increase in overall survival in several fetal diseases. In the Netherlands, fetal surgical interventions are concentrated in one center, the LUMC, a tertiary medical center which serves as the national referral center for fetal therapy. Although an increasing number of children are being born alive after fetal therapy, reliable data on the long-term neurodevelopmental outcome remain scarce. Follow-up studies are of paramount importance to increase our knowledge on the quality of long-term survival and to identify potential risk factors for adverse outcome. In this thesis, studies on the long-term neurodevelopmental outcome after fetal therapy for various fetal diseases are presented including intrauterine transfusion for fetal anemia, fetoscopic laser surgery for twin-twin transfusion syndrome and selective reduction in complicated monochorionic pregnancies. Show less
Scheltema, P.N.A. van; Zhang, A.; Ball, L.M.; Steggerda, S.J.; Wijk, R. van; Putte, D.E.F. van de; Kamp, I.L. van 2015
Fetal anemia is a serious complication in pregnancy, and is associated with perinatal mortality and morbidity. One of the major advances in the management of fetal anemia was the introduction of... Show moreFetal anemia is a serious complication in pregnancy, and is associated with perinatal mortality and morbidity. One of the major advances in the management of fetal anemia was the introduction of the intrauterine blood transfusion (IUT). This thesis presents several studies on IUT for fetal anemia. We described current indications and complications of IUT, we analyzed contributing factors for adverse perinatal outcome and we showed learning curves of for this procedure. Furthermore, we report the long-term outcome after IUT in a large cohort of children (the LOTUS study). The vast majority (over 95%) of children treated with IUT for severe alloimmune anemia have a normal neurodevelopmental outcome, confirming the success of this antenatal treatment. From the studies described in this thesis, we conclude that after more than 20 years of improved knowledge and skills, IUT is to be considered a safe and successful method to treat severe fetal anemia for different causes. Show less
Lindenburg, I.T.M.; Kamp, I.L. van; Oepkes, D. 2014
