Rus Articles Journal

And impossible is nothing?

would Seem, any more will surprise us with nothing: we receive messages on achievements of physicians with primary regularity. And still that you will tell that with 80 - x years of the XX century in medicine there was a new direction which purpose - treatment of children... till the birth? About how this idea developed, we also will talk.

Stages of a way

With emergence in 70 - x years of the 20th century of ultrasonic diagnostics - methods and devices which allow to watch development of kids till the birth experts had an opportunity to reveal the slightest deviations in this process. So there was a new direction of medicine - prenatal diagnostics. A bit later thanks to developments of geneticists experts began to study a set of chromosomes of yet not been born child, to investigate his amniotic waters (they are received, having punctured fetal covers, this method is called amniotsentez) and blood (it is about an umbilical cord puncture - a kordotsenteza). Having learned to reveal any anomalies, obstetricians and pediatricians could move further - to treatment of these violations. Today the prenatal medicine became a usual thing: already tested its opportunities are available to everyone who needs them, and studying of new continues scientists of the different countries. They see the task not only in in time to find an illness or a malformation of the kid, but also to make as much as possible exact forecast of its development after the birth. This approach opened new prospects in treatment of different violations and presented hope to thousands of future parents: today doctors pass the decision on pregnancy interruption only in case of the proved need. Important also the fact that such forecast will help experts to be prepared for reception of the sick child, that is in advance to define tactics of his treatment and, without wasting time, to give him help from first minutes of life. So what opportunities the prenatal medicine has?

the Obligatory program

First what doctors will care for, - in time to define

whether future kid is their patient. That is why each future mother uses methods of prenatal diagnostics which help to find violations in development of children. During pregnancy all women pass careful inspection more than once: blood tests and urine, BONDS - research help experts to find possible infections (syphilis, AIDS, toxoplasmosis, a rubella virus) or anomalies in development of the kid (cardiac pathology, diafragmalny hernia). Fortunately, such violations seldom - are found in only 2 - 3% of patients, but also experts can help them.

First of all to doctors should specify the diagnosis. For this purpose to future mother will appoint additional researches. For example, having found malfunctions in development of the kid on the first session of ultrasonography (on 12 - y to week of pregnancy), it will be directed to repeated ultrasonography in the center which specialists deal with this problem. OUSE - the dopplerometriya will add inspection, it will help to define whether enough nutrients the kid receives from mother with a blood-groove and whether it has problems in work of heart and kidneys. Then depending on results of the previous researches to the woman can appoint:

  • amniotsentez, since 14 - y weeks of pregnancy, the individual set of chromosomes of the child or to find an infection allowing to study;
  • research of fibers of a horion (the predecessor of a placenta so is called) to define, since 10 - y weeks, a set of chromosomes of the kid and to reveal possible genetic diseases;
  • research of fabrics of a fruit if the doctor suspects that the kid has cysts, violations in a structure or work of kidneys.
  • kordotsentez, since 18 - y weeks, the diagnosis, so far as concerns some rare anomalies of development or toxoplasmosis allows to specify
  • . By the way, thanks to this research it became clear that children of the women who caught toxoplasmosis at the beginning of pregnancy get this virus from mother in only 5% of cases. Earlier from - for impossibility to study this question till the child`s birth on light to future mothers suggested to interrupt pregnancy, toxoplasmosis is fraught with very serious violations in development of the kid.
Having decided

by li on the diagnosis and having made the forecast of development of the child in the future, experts start the treatment strategy choice.

In case of need

First of all can try to treat the kid through mother. If such option is impossible, doctors address directly the little patient - it the direction is called fetalny surgery. It includes “small“, that is sparing, interventions and “big“ serious operations. Treats the first of these two categories, for example, installation through a wall of a uterus pass - a catheter by means of ultrasonography. The purpose - to remove stress in the struck body. Act this way in case in a chest cavity of the kid there is a liquid or urine begins to accumulate in a kidney. Introduction pass - a catheter will weaken displays of an illness that will help to win time and to prolong pregnancy. It is necessary to treat the main reason for these violations only after appearance of the child on light.

Other type of the sparing interventions - pre-natal zamenny blood transfusion. It is appointed to future mothers who appeared in a situation serious a Rhesus factor - the conflict. It arises in case the negative Rhesus factor of the woman does not coincide with a Rhesus factor of the kid and her organism will begin to develop the antibodies destroying erythrocytes in the child`s blood.

Extreme manifestation of this incompatibility. Zamenny blood transfusion helps to stop its development and to prolong pregnancy. It becomes so: through an umbilical cord by means of ultrasonography (this method as you remember, is called kordotsentez) the doctor injects to the kid a drug which compensates the deficiency of erythrocytes which is available for it.

the Risky classics

Unfortunately, is situations when the kid needs the urgent help and the sparing surgical methods here not to manage. Experts tried to solve such problems by method of band surgery: the child was taken out by means of Cesarean section, did operation, and then returned “into place“. The first the American doctors made up the mind to such step: in 1989 specialists of clinic of fetalny surgery at the Californian university operated the child with diafragmalny hernia (so call a malformation of kids when internals appear in a chest cavity and squeeze a lung). And though experiment took place successfully, such type of interventions was recognized by world medical community too risky. The problem is that the section and sewing together of tissues of uterus causes fights, so, there is a risk that they will be followed by childbirth. Having refused use of methods of band surgery, experts began to look for other, less risky forms of intervention.

of Operation by means of ultrasonography

In February, 2002 the surgeon of the Boston clinic Stanton Perry performed surprising operation. By means of three-dimensional ultrasonography it entered through a uterus a hollow microscopic needle (catheter) in tiny, of the size of grape seed, the kid Jack`s heart. Afterwards it entered a cylinder, filled it with liquid to the size of 2 mm to expand the corked heart valve of the boy. To the patient of doctor Perry was... 23 weeks of pregnancy.

the Idea to use the ultrasonic device, however, for small operations, appeared long ago. Thus do zamenny blood transfusion, take amniotic waters of kids on the analysis, puncture cysts and remove outside the liquid accumulating in them. The experts who ventured to use ultrasonography for serious interventions, so far there was a little. Despite tempting prospects which are opened by an opportunity to operate kids directly in a maternal womb this idea demands very serious completion. And though such researches are conducted, experts should perform serious operations vnutriutrobno not soon.

Now experts prefer to operate with

To birthday the kids having serious problems, during the first hours lives even if for this purpose they should be hastened with birth. As prenatal diagnostics gives to doctors the chance to conduct necessary researches even during pregnancy, tactics of treatment of such children is developed in advance. Experts - obstetric crew, a neonatology, intensivists, surgeons - manage to be trained for reception of little patients. To judge whether such approach was repaid, it is possible by its results: today doctors manage to rescue such kids whose birth still quite recently was impossible.