Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-24T18:39:33.753Z Has data issue: false hasContentIssue false

Chapter 13 - Ex-Utero Intrapartum Therapy

from Section 3

Published online by Cambridge University Press:  19 November 2021

By
James Fisher ,
Timothy C. Lee  and
Mario Patino
Edited by
Olutoyin A. Olutoye
Olutoyin A. Olutoye
Affiliation:
Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
Get access

Summary

Advanced imaging of the mid-gestation fetus has allowed for the early detection and monitoring of conditions that may impact the delivery of the baby. Large head and neck masses that will likely compromise ventilation at birth can therefore be easily diagnosed with plans for securing the airway at birth. Ex-utero intrapartum therapy has greatly enhanced survival for such affected infants at birth. The success of this approach in providing advanced airway management at delivery has also been extended to the treatment of other conditions that may be life-threatening within the first few minutes to hours of life.

Keywords

cystic hygromateratomasacro-coccygeal teratomauterine relaxationfetal therapyhysterotomyairwayteroplacental circulationmulti-disciplinaryEXIT
Type
Chapter
Information
Anesthesia for Maternal-Fetal Surgery
Concepts and Clinical Practice
 , pp. 191 - 206
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mychaliska, GB, Bealer, JF, Graf, JL, et al. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg. 1997;32(2):227–230.Google Scholar
Norris, MC, Joseph, J, Leighton, BL. Anesthesia for perinatal surgery. Am J Perinatol. 1989;6(1):39–40.Google Scholar
Schwartz, MZ, Silver, H, Schulman, S. Maintenance of the placental circulation to evaluate and treat an infant with massive head and neck hemangioma. J Pediatr Surg. 1993;28(4):520–522.Google Scholar
Lazar, DA, Cassady, CI, Olutoye, OO, et al. Tracheoesophageal displacement index and predictors of airway obstruction for fetuses with neck masses. J Pediatr Surg. 2012;47(1):46–50.Google Scholar
Mong, A, Johnson, AM, Kramer, SS, et al. Congenital high airway obstruction syndrome: MR/US findings, effect on management, and outcome. Pediatr Radiol. 2008;38(11):1171–1179.Google Scholar
Saadai, P, Jelin, EB, Nijagal, A, et al. Long-term outcomes after fetal therapy for congenital high airway obstructive syndrome. J Pediatr Surg. 2012;47(6):1095–1100.Google Scholar
Hedrick, HL, Flake, AW, Crombleholme, TM, et al. The ex utero intrapartum therapy procedure for high-risk fetal lung lesions. J Pediatr Surg. 2005;40(6):1038–1043.Google Scholar
Cass, DL, Olutoye, OO, Cassady, CI, et al. EXIT-to-resection for foetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg. 2013;48(1):138–144.Google Scholar
Kunisaki, SM, Barnewolt, CE, Estroff, JA, et al. Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia. J Pediatr Surg. 2007;42(1):98–104.Google Scholar
Stoffan, AP, Wilson, JM, Jennings, RW, et al. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high-risk patients with congenital diaphragmatic hernia? J Pediatr Surg. 2012;47(6):1053–1057.Google Scholar
Shieh, HF, Wilson, JM, Sheils, CA, et al. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors? J Pediatr Surg. 2017;52(1):22–25.CrossRefGoogle ScholarPubMed
Mackenzie, TC, Crombleholme, TM, Johnson, MP, et al. The natural history of prenatally diagnosed conjoined twins. J Pediatr Surg. 2002;37(3):303–309.Google Scholar
Golombeck, K, Ball, RH, Lee, H, et al. Maternal morbidity after maternal-fetal surgery. Am J Obstet Gynecol. 2006;194(3):834–839.Google Scholar
American College of Obstetricians and Gynecologists, Committee on Ethics; American Academy of Pediatrics, Committee on Bioethics. Maternal-fetal intervention and fetal care centers. Pediatrics. 2011;128(2):e473–478.CrossRefGoogle Scholar
Gaiser, R. Physiologic changes of pregnancy. In: Chestnut, DH, ed. Chestnut’s Obstetric Anesthesia: Principles and Practice. Elsevier Saunders, 2014; 15–38.Google Scholar
Ueyama, H, Hagihira, S, Takashina, M, et al. Pregnancy does not enhance volatile anesthetic sensitivity on the brain: an electroencephalographic analysis study. Anesthesiology. 2010;113(3):577–584.CrossRefGoogle ScholarPubMed
Flood, P, Rollins, MD. Anesthesia for obstetrics. In: Miller, RD, ed. Miller’s Anesthesia. Saunders, 2015; 2328–2358.Google Scholar
Munnur, U, de Boisblanc, B, Suresh, MS. Airway problems in pregnancy. Crit Care Med. 2005;33(10 Suppl):S259–268.Google Scholar
Kinsella, SM, Lohmann, G. Supine hypotensive syndrome. Obstet Gynecol. 1994;83(5 Pt 1):774–788.Google Scholar
Marwan, A, Crombleholme, TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg. 2006;15(2):107–115.CrossRefGoogle ScholarPubMed
Ng, K, Parsons, J, Cyna, AM, et al. Spinal versus epidural anaesthesia for caesarean section. Cochrane Database Syst Rev. 2004;(2):CD003765.Google Scholar
Apfelbaum, JL, Hagberg, CA, Caplan, RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–270.Google Scholar
Balki, M, Cooke, ME, Dunington, S, et al. Unanticipated difficult airway in obstetric patients: development of a new algorithm for formative assessment in high-fidelity simulation. Anesthesiology. 2012;117(4):883–897.Google Scholar
Zakowski, MI, Geller, A. The placenta: anatomy, physiology and transfer of drugs. In: Chestnut, DH, ed. Chestnut’s Obstetric Anesthesia: Principles and Practice. Elsevier Saunders, 2014;55–74.Google Scholar
Ngan Kee, WD, Khaw, KS, Ng, FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 2004;92(4):469–474.Google Scholar
Ngan Kee, WD, Lee, A, Khaw, KS, et al. A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control. Anesth Analg. 2008;107(4):1295–1302.Google Scholar
Boat, A, Mahmoud, M, Michelfelder, EC, et al. Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery. Paediatr Anaesth. 2010;20(8):748–756.Google Scholar
Ngamprasertwong, P, Michelfelder, EC, Arbabi, S, et al. Anesthetic techniques for fetal surgery: effects of maternal anesthesia on intraoperative fetal outcomes in a sheep model. Anesthesiology. 2013;118(4):796–808.Google Scholar
George, RB, Melnick, AH, Rose, EC, et al. Case series: Combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth. 2007;54(3):218–222.CrossRefGoogle ScholarPubMed
Clark, KD, Viscomi, CM, Lowell, J, et al. Nitroglycerin for relaxation to establish a fetal airway (EXIT procedure). Obstet Gynecol. 2004;103(5 Pt 2):1113–1115.Google Scholar
El-Sayed, Y, Riley, E, Holbrook, H, Cohen, S, et al. Randomized comparison of intravenous nitroglycerin and magnesium sulfate for treatment of preterm labor. Obstet Gynecol. 1999;93(1):79–83.Google ScholarPubMed
Brusseau, R, Mizrahi-Arnaud, A. Fetal anesthesia and pain management for intrauterine therapy. Clin Perinatol. 2013;40(3):429–442.Google Scholar
Kaneko, M, Tokunaga, S, Mukai, M, et al. Application of a fetal scalp electrode for continuous fetal heart rate monitoring during an ex utero intrapartum treatment. J Pediatr Surg. 2011;46(2):e37–40.Google Scholar
Müller, T, Nanan, R, Rehn, M, et. al. Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: longitudinal analysis. Fetal Diagn Ther. 2003;18(3):163–169.Google Scholar
Smith, GC, Cameron, AD. Estimating human fetal blood volume on the basis of gestational age and fetal abdominal circumference. BJOG. 2002;109(6):721–722.CrossRefGoogle ScholarPubMed
Lazar, DA, Olutoye, OO, Moise, KJ, et al. Ex-utero intrapartum treatment procedure for giant neck masses – fetal and maternal outcomes. J Pediatr Surg. 2011;46(5):817–822.CrossRefGoogle ScholarPubMed
Laje, P, Johnson, MP, Howell, LJ, et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediatr Surg. 2012;47(6):1208–1216.CrossRefGoogle ScholarPubMed
Laje, P, Howell, LJ, Johnson, MP, et al. Perinatal management of congenital oropharyngeal tumors: the ex utero intrapartum treatment (EXIT) approach. J Pediatr Surg. 2013;48(10):2005–2010.Google Scholar
Noah, MM, Norton, ME, Sandberg, P, et al. Short-term maternal outcomes that are associated with the EXIT procedure, as compared with caesarean delivery. Am J Obstet Gynecol. 2002;186(4):773–777.Google Scholar
Zamora, IJ, Ethun, CG, Evans, LM, et al. Maternal morbidity and reproductive outcomes related to fetal surgery. J Pediatr Surg. 2013;48(5):951–955.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×