Open<unk>  Technique Tocolytics are generally given to prevent labor; however, these should not be given if the risk is higher for the fetus inside the womb than if delivered, such as may be the case in intrauterine infection, unexplained vaginal bleeding and<unk>  distress. An H2 antagonist is usually given for anaesthesia the evening before and the morning of the operation, and an antacid is usually given before induction to reduce the risk of acid aspiration. Rapid sequence induction is often used for sedation and intubation. Open<unk>  is similar in many respects to a normal cesarean section performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus. A hysterotomy is performed on the pregnant woman, and once the uterus is open and the fetus is exposed, the<unk>  begins. Typically, this<unk>  consists of an interim procedure intended to allow the fetus to remain in utero until it has matured enough to survive delivery and neonatal surgical procedures. Upon completion of the<unk> , the fetus is put back inside the uterus and the uterus and abdominal wall are closed up. Before the last stitch is made in the uterine wall, the amniotic fluid is replaced. The mother remains in the hospital for 3–7 days for monitoring. Often babies who have been operated on in this manner are born pre-term. Safety and complications The main priority is maternal safety, and, secondary, avoiding preterm labor and achieving the aims of the<unk> . In 2008, open<unk>  was considered a possibility after approximately 18 weeks of gestation due to<unk>  size and fragility before that, and up to approximately 30 weeks of gestation due to increased risk of premature labor and, practically, the preference for delivering the child and performing the<unk>  in ex utero/pediatric<unk> , instead. The risk of premature labor is increased by concomitant risk factors such as multiple gestation, a history of maternal smoking, and very young or old maternal age. Open<unk>  has proven to be reasonably safe for the mother. For the fetus, safety and effectiveness are variable, and depend on the specific procedure, the reasons for the procedure, and the gestational age and condition of the fetus. The overall perinatal mortality after open<unk>  has been estimated to be approximately 6%, according to a study in the United States 2003. All future pregnancies for the mother require cesarean delivery because of the hysterotomy. However, there is no presented data suggesting decreased fertility for the mother. Indications Neural tube defects (NTD), which begin to become observable at the 28th day of pregnancy, occur when the embryonic neural tube fails to close properly, the developing brain and spinal cord are openly exposed to amniotic fluid and with this, causes the nervous system tissue to break down. Prenatal repair of the most easily treated NTD, myelomeningocele (spina bifida cystica) is as of 2011, a growing option in the United States. Although the procedure is technically challenging, children treated with open<unk>  repair have significantly improved outcomes compared to children whose defects are repaired shortly after birth. Specifically,<unk>  repair reduces the rate of ventriculoperitoneal shunt dependence and Chiari malformation, while improving motor skills at 30 months of age compared to post-natal repair. Children having<unk>  repair are twice as likely to walk independently at 30 months of age than children undergoing post-natal repair. As a result, open<unk>  repair of spina bifida is now considered standard of care at<unk>  specialty centers. Other conditions that potentially are treated by open<unk>  include: * Congenital diaphragmatic hernia (if indicated at all, it is now more likely to be treated by endoscopic<unk>  * Congenital cystic adenomatoid malformation * Congenital heart disease * Pulmonary sequestration * Sacrococcygeal teratoma Minimally invasive<unk>  Minimally-invasive fetoscopic<unk>  has proven to be useful for some<unk>  conditions. * Twin-twin transfusion syndrome – Laser Ablation of Vessels * Spina bifida – Fetoscopic closure of the malformation. Prenatal repair of the spina bifida lesion through this approach has been purported to result in less complications to the mother, whilst affording benefit to the baby.
Fetal surgery
Post-abortion care
Pre-conception counseling
Egg donation
Prenatal nutrition
Prenatal care
Birth control
Birth control 