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[Approach to a new compensatory management of the hypotrophic fetus]
This is a report on a new possibility of effecting direct compensatory supply of vitally essential substances on the hypotrophic foetus. Supply of amino acids and other important substances is effected via an indwelling catheter introduced into the abdominal cavity of the foetus. To avoid infections it is advisable to provide for sufficiently long tunnelling of the mother's skin and to implant an application capsule into the abdominal wall of the mother in such a manner that the system is in no way openly connected to the outside, treatment being effected transcutaneously through the mother's skin. It is well known from peritoneal dialyses that the peritoneum is highly permeable especially for low molecular substances. A report is given on a case where the system could however be applied for 9 days only because of premature rupture of the foetal membranes and subsequent birth of a viable child. During the intraperitoneal supply of the foetus it was possible to show by instillation of 13C leucine (effected in cooperation with paediatricians) that the foetus had taken up the supplied amino acids and had metabolised and excreted these via the placenta and finally the mother's expiratory air to a slight extent only; the major part had, therefore, been utilised for anabolism. The article discusses potential risks that can be envisaged at the present moment, such as intestinal injuries during puncture, infections and premature rupture of the membranes.
This is a report on a new possibility of effecting direct compensatory supply of vitally essential substances on the hypotrophic foetus. Supply of amino acids and other important substances is effected via an indwelling catheter introduced into the abdominal cavity of the foetus. To avoid infections it is advisable to provide for sufficiently long tunnelling of the mother's skin and to implant an application capsule into the abdominal wall of the mother in such a manner that the system is in no way openly connected to the outside, treatment being effected transcutaneously through the mother's skin. It is well known from peritoneal dialyses that the peritoneum is highly permeable especially for low molecular substances. A report is given on a case where the system could however be applied for 9 days only because of premature rupture of the foetal membranes and subsequent birth of a viable child. During the intraperitoneal supply of the foetus it was possible to show by instillation of 13C leucine (effected in cooperation with paediatricians) that the foetus had taken up the supplied amino acids and had metabolised and excreted these via the placenta and finally the mother's expiratory air to a slight extent only; the major part had, therefore, been utilised for anabolism. The article discusses potential risks that can be envisaged at the present moment, such as intestinal injuries during puncture, infections and premature rupture of the membranes.