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Why should you receive treatment
for fetal in AMC?
AMC opened the Fetal Treatment Center in July of 2004, which was a period that around 3~4% of newborns were born with fetal anomalies. The opening of Fetal Treatment Center was the first time in Korea, and the center was to provided information and treatment of the diseases of the fetus through accurate prenatal diagnosis by high-resolution ultrasonography.
The Fetal Treatment Center performs around 4,000 high-resolution ultrasonography, amniocentesis, chorionic villus sampling, umbilical cord blood test, amnioinfusion, amnioreduction, amnioexchange, fetal ovarian cyst aspiration, fetal shunt procedures, fetal radiofrequency ablation, fetal transfusion, and fetoscopic surgery every year. This performance is the largest amount done per year in Korea.
One of the best services of the center is the ability to check and diagnose fetal anomalies by an ultrasound screening. At the same time, the center provides consultation for parents on the postnatal treatment. The center also has a collaborative system of relevant departments of pediatrics, pediatric cardiology, pediatric surgery, pediatric thoracic & cardiovascular surgery, pediatric urology, pediatric neurology, and pediatric plastic surgery. It facilitates the treatment of a baby immediately after birth.
Prenatal diagnosis of major fetal diseases
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Classification
Name of disease
Central Nervous System Disorders
Ventriculomegaly
Neural Tube Defect
Dandy-Walker Malformation
Agenesis of Corpus Callosum
Face and Neck Disorders
Cleft Lip, Cleft Palate
Fetal Goiter
Chest Disorders
Congenital Cystic Adenomatoid Malformation
Pulmonary Sequestration
Pleural Effusion
Congenital Diaphragmatic Hernia
Congenital Heart Disorders
Ventricular Septal defect, Atrioventricular Septal Defect, Pulmonic Valve Stenosis, Coarctation of Aorta, Tetralogy of Fallot, Transposition of Great Arteries, Pulmonary Atresia, Aortic Valve Insufficiency, Ebstein Anomaly, Hypoplastic Left Heart Syndrome, etc.
Gastro-enteric System Disorders
Duodenal Atresia
Imperforate Anus
Abdominal Wall Disorders
Gastroschisis
Omphalocele
Urinary System Disorders
Hydronephrosis
Multicystic Dysplastic Kidney
Posterior Urethral Valve Syndrome
Renal Agenesis
Musculoskeletal System Disorders
Skeletal Dysplasia
Clubfoot
Sacrococcygeal Teratoma
Twin Pregnancy Disorders
Twin to Twin Transfusion Syndrome
Discordant Twin
Other Fetal Disorders
Hydrops Fetalis
Placenta and Amniotic Fluid Diseases
Fetal Anemia
Major treatments
Medical Care
Fetal Hypothyroidism Treatment: Inject thyroxine into the amniotic fluid and prescribe oral thyroid medication to the mother.
Amnioinfusion, Amnioreduction
Fetal Transfusion
Fetal transfusion is one of the treatments for fetal anemia caused by various reasons. Transfusion involves finding the umbilical vein by ultrasound guidance to perform a venipuncture on the placental site and to check if there is fetal blood reflux. After the verification, a small quantity of blood sample will be taken to perform testing of hematocrit, hemoglobin, etc. After the exam, the estimated dose of blood will be transfused.
Fetal thoracentesis and paracentesis
This medical approach is used first to determine the cause and treat symptoms when fluid is accumulated in the pleural or peritoneal cavity of the fetus. Using a real-time ultrasonography, a needle is inserted into the uterus without touching the placenta and the umbilical cord to reach the pleural or peritoneal cavity of the fetus, removing the fluid.
Samples of pleural or ascitic fluid are taken to analyze the contents, identify the cause, and predict the prognosis of treatment. The results are used to prevent imperfect fetal lung maturation caused by an excessive amount of pleural fluid and ascitic fluid to help the fetus intake amniotic fluid.
Fetal Shunting
Fetal shunting is a procedure to drain fluid from a fluid-filled fetal space into the amniotic cavity. It is an ultrasound-guided percutaneous procedure which is less invasive than open surgery or fetoscopic surgery, but indications are limited.
The procedure is performed under a real-time ultrasonography. If the posture and location of the fetus are inappropriate, the procedure may be delayed or fail. In rare cases, reoperation may be needed if a basket is deviated by the fetus’ movement inside the uterus. Complications such as preterm premature rupture of membranes, preterm labor, and premature birth and stillbirth caused by infection rarely happen, so patients require hospitalization for the procedure and intensive monitoring and care.
Radiofrequency Ablation (RFA)
Radiofrequency ablation (RFA) is a medical procedure in which a lesion is pricked with a needle and the tissue around the lesion is ablated by using the heat generated from the medium frequency alternating current. It can be applied to the fetus during pregnancy, and often performed on monochorionic twin and sacrococcygeal teratoma.
Fetoscopic Surgery
Recent study results reported that fetoscopic selective laser coagulation (FSLC) is the most advanced treatment in TTTS (twin to twin transfusion syndrome). Laser therapy is performed under local anesthesia, epidural anesthesia, or spinal anesthesia. A small incision is made in the skin, and a trocar is placed into it by ultrasound guidance. Then, fetoscopy is inserted to find the placental vascular anastomosis and coagulate it with laser beams.
AMC’s Treatment Performance
2005 : Succeeded in the world’s first fetal shunting in a 13th-week fetus with ventriculomegaly
May 2012 : Succeeded in fetoscopic selective laser coagulation and healthy baby was delivered
Jan. 2016 : Performed Korea’s first balloon therapy on a fetus with a congenital valve disease during pregnancy without heart surgery
As of Dec. 2016 : Performed around 410 fetal shunting procedures, around 70 radiofrequency catheter ablations, and 107 fetal transfusions as well as 132 fetoscopic selective laser coagulations which were initiated in 2012.
