Prenatal assessment and prediction in CDH: for what purpose?

Congenital diaphragmatic hernia is most often diagnosed prenatally, and accurate assessment is crucial for prognosis parental counselling and therapeutic planning. The assessment of pulmonary hypoplasia is currently the most relevant prognostic indicator. Ultrasound and MRI parameters such as the observed-to-expected lung-to-head ratio and total fetal lung volume serve as the primary predictors of neonatal outcome.

The Lancet Child & Adolescent Health Commission on the future of neonatology.

Neonatal mortality remains unacceptably high throughout the world. Survival of sick infants in their first month of life has improved over the past six decades. However, many comorbidities persist, with lifelong implications for health.

The Vortex shunt: Short-term feasibility studies in the fetal lamb model of lower urinary tract obstruction and pleural effusion.

Background: The suboptimal shunt design of the currently available vesico-amniotic and thoraco-amniotic shunts is likely at tributed to the risk of shunt failure, either by displacement, kinking, or obstruction, resulting in treatment failure and the need for additional fetal intervention.

Objective: To evaluate the feasibility of ultrasound-guided insertion, drainage, and short-term dislodgement risks of the novel Vortex shunt in fetal lambs with surgically induced lower urinary tract obstruction (LUTO) and pleural effusion.

Study Design: LUTO was surgically created in eight fetal lambs at a median of 71 days (range 69-72; term = 145) gestation.

Cost-Minimization Study of Glue versus Sutured Mesh Fixation in Laparoscopic Sacrocolpo(recto)pexy.

Objectives: The objective of the study was to conduct a cost-minimization analysis of laparoscopic sacrocolpo(recto)pexy (LSCP) using either synthetic glue or sutures alone for mesh fixation.

Design: A cost-minimization study comparing two single-center consecutive cohorts (n = 20 each), evaluating differences in consumables and operating room costs for LSCP, performed either with sutures alone or synthetic glue for mesh fixation (January 2021 to December 2021).

Participants: All patients underwent LSCP using the same standardized technique performed by one of two gynecologic surgeons experienced in LSCP (≥50 procedures per year), both proficient in using sutures or glue for LSCP, to minimize any learning curve bias.

The Fall Out of the 2017 European Medical Device Regulation for Tracheal Occlusion.

Objective: The use of the Balt Goldbal-balloon and Baltacci-catheter in Fetoscopic Endoluminal Tracheal Occlusion is affected by the 2017-European Medical Device Regulation, which necessitates recertification even for devices long considered safe. This regulation has led the manufacturer to stop distributing these devices in Europe. We alert fetal surgery centers to these challenges and regulators to the broader impact on the availability of fetal therapy devices in Europe.

Vaginal Erbium Laser Versus Pelvic Floor Muscle Training for Stress Urinary Incontinence: A Randomised Controlled Trial.

Introduction And Hypothesis: Current studies on vaginal laser therapy for the management of stress urinary incontinence (SUI) are inconclusive, and many lack comparison with another conservative treatment. Therefore, we compared the efficacy of Er:YAG laser for SUI with that of pelvic floor muscle training (PFMT).

Methods: Single-centre, randomised controlled trial comparing laser treatment (3-6 applications) with PFMT (9-18 sessions) in women with mild to moderate SUI.

Proctored single surgeon learning curve for vaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy.

Objective: We studied the learning curve of vaginally assisted NOTES hysterectomy (VANH) for individual surgical steps and competence scores.

Design: Single centre, prospective cohort study in a Belgian teaching hospital.

Measurements And Main Results: In a cohort of 57 women undergoing VANH we analysed 29 procedures performed completely or partly by the novice and 35 procedures performed completely or partly by the expert.

Prenatal VEGF Nanodelivery Reverses Congenital Diaphragmatic Hernia-associated Pulmonary Abnormalities.

Congenital diaphragmatic hernia (CDH) results in lung hypoplasia. In severe cases, tracheal occlusion (TO) can be offered to promote lung growth. However, the benefit is limited, and novel treatments are required to supplement TO.

The Association Between Levator Ani Integrity and Postpartum Ano-Rectal Dysfunction: A Systematic Review.

Introduction And Hypothesis: Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth.

Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model.

Background: General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia.

End-tidal concentration of sevoflurane for optimal surgical conditions in pregnant sheep: a pragmatic approach to a retrospective observational study.

The aim of this pragmatic approach to retrospective observational study was to identify the end-tidal concentration of sevoflurane which was associated with optimal surgical conditions (i.e., absence of any movement, coughing and straining) in 127 pregnant sheep.

Pelvic Floor Ultrasound Findings and Symptoms of Pelvic Floor Dysfunction During Pregnancy.

Introduction And Hypothesis: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS.

Evidence of time dependent degradation of polypropylene surgical mesh explanted from the abdomen and vagina of sheep.

The failure of polypropylene mesh is marked by significant side effects and debilitation, arising from a complex interplay of factors. One key contributor is the pronounced physico-mechanical mismatch between the polypropylene (PP) fibres and surrounding tissues, resulting in substantial physical damage, inflammation, and persistent pain. However, the primary cause of sustained inflammation due to polypropylene itself remains incompletely understood.

Experimental Induction of Complex Gastroschisis in the Fetal Lamb: Systematic Review.

We systematically reviewed experiments in the fetal lamb model of gastroschisis using PubMed, Embase, Web of Science, and Scopus, seeking for standardized surgical techniques to obtain complex gastroschisis. Eligible were studies where an abdominal wall defect was surgically induced and gross anatomical findings at birth were available. The primary outcome was complex gastroschisis, defined by the presence of bowel stenosis, atresia, volvulus, perforation, and/or necrosis.

FERN: is it possible to conduct a randomised controlled trial of intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy - protocol for a prospective multicentre mixed-methods feasibility study.

Introduction: Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy carries a risk of death of the smaller twin, with a high risk of co-twin demise (40%) or co-twin neurological sequelae (30%). On the other, early delivery to prevent the death of the smaller twin may expose the larger twin to prematurity, with the associated risks of long-term physical, emotional and financial costs from neurodisability, such as cerebral palsy.

Approaches for hysterectomy and implementation of robot-assisted surgery in benign gynaecological disease: A cost analysis study in a large university hospital.

Background: As a minimally invasive technique, robot-assisted hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy.

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.

Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.

Design: Cross-sectional survey.

Setting: International.

Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study.

Background: Temporary fetoscopic endoluminal tracheal occlusion (FETO) promotes lung growth and increases survival in selected fetuses with congenital diaphragmatic hernia (CDH). FETO is performed percutaneously by inserting into the trachea a balloon designed for vascular occlusion. However, reports on the potential postnatal side-effects of the balloon are scarce.

Three-Dimensional Transperineal Ultrasound Assessment of the Anal Sphincter Immediately After Vaginal Birth: An Exploratory Study.

Objectives: To assess the feasibility of acquiring adequate transperineal ultrasound (TPUS) volumes of the anal sphincter (AS) immediately after vaginal birth, the reproducibility of its measurements, and detecting defects therein.

Methods: Secondary analysis of TPUS volumes of the AS, acquired immediately after vaginal birth with a transversely oriented convex probe. Two independent experts ranked off-line image quality as "inadequate," "adequate," or "ideal" using the Point-of-Care Ultrasound Image Quality scale.