www.medicinafetalbarcelona.org/
Eduard Gratacós BCNatal - Centro de Medicina Maternofetal y Neonatología Barcelona,
Hospital Clinic y Hospital Sant Joan de Deu www.fetalmedicinebarcelona.org
DOLOR FETAL E IMPLICACIONES EN MEDICINA FETAL
Fetal Medicine & Therapy§ recent development!
§ high tech!
§ multidisciplinarity!
§ fetal surgery!
§ referral activity!
§ increasing importance!
§ high legal pressure
www.medicinafetalbarcelona.org/
Evolution of social demands in Fetal Medicine & Therapy: !the fetus as a patient
society of information
perception fetus as a person
capacity !Dx & Tx
DEMANDS
www.medicinafetalbarcelona.org/
Levels in Fetal Medicine!integration in public health
Advanced studies
Diagnosis1
2
3
US-guided fetal therapy
Endoscopic therapy & Fetal Surgery
Primary level
Tertiary Hospital!(1 in 300,000)
Fetal surgery Center!(1 in 15-20 million)
Levels in Fetal Medicine!integration in public health
www.medicinafetalbarcelona.org/
Complexity!Multidisciplinarity
Pregnancies
0.2%!(1 in >1,000)
5 % Advanced Fetal Medicine !Tertiary Center
Fetal surgery center!National or transnational level
Public Health System
100 %
Levels in Fetal Medicine!integration in public health
www.medicinafetalbarcelona.org/
Key Hole Surgery
FETAL SURGERY ≈ FETOSCOPY"!
• fetus ≠ smaller neonate!!
• uterus and mother not operable
www.fetalmedicinebarcelona.org/
FETAL THERAPY MUST BE NICE FOR PATIENTS NOT FOR DOCTORS ( “PIONEERS TIME” IS OVER)
Percutaneous Feto-Endoscopic Tracheal Occlusion!
Deprest J, Gratacos E, Nicolaides K. UOG 04
• increase airways pressure
• accelerated growth • first case: oct 01 • currently >500 !
TOTAL RCT international trial ongoing
LUNG DEFECTS
Bronchial atresia
Martinez et al. Fetal Diagn Ther 2013
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
Fetal surgery for spina bifida
www.medicinafetalbarcelona.org/
Desarrollo neurológico fetal 12s
20s
M: 28-30s
24s
www.medicinafetalbarcelona.org/
Fetal and neonatal pain
Anand KJ et al!Pre-term neonates exert hormonal responses to painful stimulus. !!Anand et al. - Fisk et al.!Premature fetus: hormonal + hemodynamic responses to invasive stimuli.!Can be blocked by analgesia.!Clear responses from 24 w!Conflicting data from 16 w
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
Dolor, desarrollo neurológico fetal y analgesia fetal
Experimental and clinical data (Anand et al): !Neonatal pain is associated with altered pain thresholds
www.medicinafetalbarcelona.org/
Terapia fetal !<22s: vencuronio !>22s: vencuronio fentanil atropina !Materna: !-Fetoscopia: Sedación materna Remifentanilo (Vandevelde et al 2005) !-Cirugía abierta: anestesia general (+ anestesia fetal)
www.medicinafetalbarcelona.org/
Eduard Gratacós BCNatal - Centro de Medicina Maternofetal y Neonatología Barcelona,
Hospital Clinic y Hospital Sant Joan de Deu www.fetalmedicinebarcelona.org
DOLOR FETAL E IMPLICACIONES EN MEDICINA FETAL
