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Ex utero intrapartum

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https://www.readbyqxmd.com/read/29904479/massive-fetal-cervical-teratoma-managed-with-the-ex-utero-intrapartum-treatment-exit-procedure
#1
Emily Olivares, Justin Castellow, Jamil Khan, Susanne Grasso, Victor Fong
Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor...
April 2018: Radiology Case Reports
https://www.readbyqxmd.com/read/29842812/management-of-chaos-by-intact-cord-resuscitation-case-report-and-literature-review
#2
Manisha Kumar, Amit Gupta, Vijay Kumar, Anu Handa, Mayura Balliyan, Jyoti Meena, Shubhasis Roychoudhary
BACKGROUND: Congenital high airway obstruction syndrome (CHAOS) is a near fatal condition, except when the ex-utero intrapartum treatment (EXIT) procedure is performed as rescue. After antenatal diagnosis of the condition counseling regarding prognosis and outcome needs to be provided Case: We describe here a case with CHAOS due to isolated fetal laryngeal atresia, presented at our center at 33-week gestation. After counseling regarding the uncertain outcome, consent for elective caesarean was not given...
May 29, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29803315/fetoscopic-therapy-for-severe-pulmonary-hypoplasia-in-congenital-diaphragmatic-hernia-a-first-in-prenatal-regenerative-medicine-at-mayo-clinic
#3
Rodrigo Ruano, Denise B Klinkner, Karthik Balakrishnan, Victoria A Novoa Y Novoa, Norman Davies, Dean D Potter, William A Carey, Christopher E Colby, Amy B Kolbe, Katherine W Arendt, Leal Segura, Hans P Sviggum, Maureen A Lemens, Abimbola Famuyide, Andre Terzic
OBJECTIVE: To introduce the prenatal regenerative medicine service at Mayo Clinic for fetal endoscopic tracheal occlusion (FETO) care for severe congenital diaphragmatic hernia (CDH). PATIENTS AND METHODS: Two cases of prenatal management of severe CDH with FETO between January and August 2017 are reported. Per protocol, FETO was offered for life-threatening severe CDH at between 26 and 29 weeks' gestation. Regenerative outcome end point was fetal lung growth. Gestational age at procedure and maternal and perinatal outcomes were additional monitored parameters...
May 15, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29780786/-ex-utero-intrapartum-treatment-procedure-in-two-fetuses-with-airway-obstruction
#4
Joohee Lee, Mi-Young Lee, Yeni Kim, Jae-Yoon Shim, Hye-Sung Won, Euiseok Jeong, Byong Sop Lee, Ki-Soo Kim, Woo-Jong Choi, Yoon Se Lee
The ex utero intrapartum treatment (EXIT) procedure was introduced to reduce fetal hypoxic damage while establishing an airway in fetuses with upper and lower airway obstruction. Delivery of the fetal head and shoulders while maintaining the uteroplacental circulation offers time to secure the fetal airway. Here, we report two cases of EXIT procedure for fetal airway obstruction, which were successfully managed with extensive preoperative planning by a professional multidisciplinary team.
May 2018: Obstetrics & Gynecology Science
https://www.readbyqxmd.com/read/29662285/ex-utero-intrapartum-treatment-exit-for-a-large-fetal-neck-mass
#5
Manisha M Beck, Ekta Rai, Reeta Vijayaselvi, Mary John, Naina Picardo, Sridhar Santhanam, Maneesh Kumar, Benjamin J Ross
No abstract text is available yet for this article.
April 2018: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/29508360/ex-utero-intrapartum-treatment-for-giant-congenital-omphalocele
#6
Xu-Yong Chen, Ji-Xin Yang, Hong-Yi Zhang, Xiao-Feng Xiong, Khalid Mohamoud Abdullahi, Xiao-Juan Wu, Jie-Xiong Feng
BACKGROUND: To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles. METHODS: We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed...
March 5, 2018: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/29495013/high-tumor-volume-to-fetal-weight-ratio-is-associated-with-worse-fetal-outcomes-and-increased-maternal-risk-in-fetuses-with-sacrococcygeal-teratoma
#7
Juliana S Gebb, Nahla Khalek, Huma Qamar, Mark P Johnson, Edward R Oliver, Beverly G Coleman, William H Peranteau, Holly L Hedrick, Alan W Flake, N Scott Adzick, Julie S Moldenhauer
OBJECTIVE: Tumor volume to fetal weight ratio (TFR) > 0.12 before 24 weeks has been associated with poor outcome in fetuses with sacrococcygeal teratoma (SCT). We evaluated TFR in predicting poor fetal outcome and increased maternal operative risk in our cohort of SCT pregnancies. METHODS: This is a retrospective, single-center review of fetuses seen with SCT from 1997 to 2015. Patients who chose termination of pregnancy (TOP), delivered elsewhere, or had initial evaluation at > 24 weeks were excluded...
March 1, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29447823/exit-ex-utero-intrapartum-treatment-in-a-growth-restricted-fetus-with-tracheal-atresia
#8
S Kyle Gonzales, Steven Goudy, Kara Prickett, Jane Ellis
Congenital high airway obstruction syndrome (CHAOS) encompasses a heterogeneous group of pathologies leading to poor lung development and difficulty oxygenating the newborn after delivery. While previously uniformly fatal, the ex utero intrapartum therapy (EXIT) procedure has provided a method to treat these patients and provide an airway to potentiate survival. We present a patient diagnosed prenatally with CHAOS secondary to tracheal atresia complicated by severe intra-uterine growth restriction (IUGR) who was successfully delivered via an EXIT procedure at 33-weeks...
February 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29447817/mature-and-immature-pediatric-head-and-neck-teratomas-a-15-year-review-at-a-large-tertiary-center
#9
Harish Dharmarajan, Noémie Rouillard-Bazinet, Binoy M Chandy
INTRODUCTION: Pediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established. OBJECTIVES: To review the management and outcomes of pediatric head and neck teratomas. To distinguish differences between mature and immature tumors with respect to the age at presentation and surgery, tumor size and location, alpha fetoprotein (AFP) levels, airway management, and recurrence...
February 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29438655/short-term-neurodevelopmental-outcome-in-children-born-with-high-risk-congenital-lung-lesions
#10
Enrico Danzer, Casey Hoffman, Jo Ann D'Agostino, Matthew M Boelig, Marsha Gerdes, Judy C Bernbaum, Hannah Rosenthal, Lindsay N Waqar, Natalie E Rintoul, Lisa M Herkert, Michael J Kallan, William H Peranteau, Alan W Flake, N Scott Adzick, Holly L Hedrick
BACKGROUND: This study sought to evaluate neurodevelopmental outcome in survivors of high-risk congenital lung lesions (CLLs) who underwent prenatal intervention or postnatal surgery within the first month of life. METHODS: Forty-five high-risk CLL survivors underwent assessment using the Bayley Scales of Infant Development, 3rd Edition between July 2004 and December 2016. Scores were grouped as average, at-risk, and delayed based on SD intervals. Correlations between outcome and risk factors were analyzed by Fisher's exact test or two-sided t test as appropriate, with significant p values <0...
February 10, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29187760/the-exit-ex-utero-intrapartum-treatment-procedure-from-the-paediatric-ent-perspective
#11
B Pucher, J Szydlowski, K Jonczyk-Potoczna, J Sroczynski
The main principle of the EXIT procedure is to maintain uteroplacental circulation with neonatal anaesthesia by controlled uterine hypotonia. This enables securing the foetal airways and decompress or resect large neck and mediastinal foetal masses. The authors present their experience with use of the EXIT procedure in 7 foetuses in whom evaluation and management of the airways were performed. In 4 patients, the neck mass was surgically removed in the neonatal period, in 1 the propranolol treatment was introduced...
November 30, 2017: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/29049800/ex-utero-intrapartum-treatment-to-extracorporeal-membrane-oxygenation-followed-by-cardiac-operation-for-truncus-arteriosus-communis
#12
Hidetsugu Asai, Tsuyoshi Tachibana, Yasushige Shingu, Yoshiro Matsui
Extracorporeal membrane oxygenation has been recently indicated as an ex utero intrapartum treatment procedure for placental support in patients with a large thoracic mass. In our case, a foetus with truncus arteriosus communis and hydrops with ventricular failure due to severe truncal valve stenosis was delivered under ex utero intrapartum treatment-to-extracorporeal membrane oxygenation at 34 weeks of gestation. The neonate underwent truncal valve plasty. He could be weaned off extracorporeal membrane oxygenation, but he died because of the infection on postnatal Day 24...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28992728/use-of-ex-utero-intrapartum-treatment-procedure-in-fetal-neck-and-high-airway-anomalies-report-of-four-clinical-cases
#13
Jakub Kornacki, Jarosław Szydłowski, Jana Skrzypczak, Małgorzata Szczepańska, Marcin Rajewski, Agnieszka Koziołek, Michał Gaca, Ewa Wender-Ożegowska
PURPOSE: To present antenatal management and use of ex utero intrapartum treatment (EXIT) in different fetal neck and high airway anomalies. MATERIAL AND METHODS: We have presented four different cases of fetal neck or airway pathology which were indications for EXIT, at our department. RESULTS: In three cases of fetal neck tumors, the primary precise antenatal diagnoses of tumors were confirmed after birth. The airways of all three fetuses were properly secured during EXIT by laryngologist...
October 26, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28949025/perinatal-diagnosis-and-management-of-oropharyngeal-fetus-in-fetu-a-case-report
#14
Yangyang R Yu, Jimmy Espinoza, Deepak K Mehta, Sundeep G Keswani, Timothy C Lee
Fetus in fetu is an extremely rare congenital anomaly. We describe the perinatal diagnosis and management of a fetus with oropharyngeal and cervical fetus in fetu. High-resolution ultrasonography with 3-dimensional rendering can identify increased risks of airway obstruction in utero. Early identification allows a multidisciplinary team to be assembled for a scheduled ex utero intrapartum treatment procedure.
May 2018: Journal of Clinical Ultrasound: JCU
https://www.readbyqxmd.com/read/28915526/-exit-a-possible-intervention-for-new-and-earlyborn-babies-with-severe-hydrops-fetalis-and-hydrothoraces-on-both-sides
#15
Sandra Koch, Jochen Essers, Ortraud Beringer, Frank Reister, Helmut Hummler, Anja Moewes
The EXIT (ex utero intrapartum treatment) procedure is an established method of respiratory protection, originally used in the delivery of fetuses with congenital obstructive airway diseases (tumors in the throat area, hygromas, so-called congenital high airway obstruction syndrome (CHAOS)). Meanwhile, the procedure is also carried out in large perinatal centers for pronounced diaphragmatic hernia or other special indications (EXIT to ECMO, congenital lung airway malformations (CCAM), pulmonary atresia). We present our experience with adapted EXIT procedures in 5 preterm infants with secondary generalized hydrops fetalis and pronounced bilateral hydrothoraces...
December 2017: Zeitschrift Für Geburtshilfe und Neonatologie
https://www.readbyqxmd.com/read/28805620/ex-utero-intrapartum-treatment-for-extremely-low-birth-weight-neonates-requiring-resuscitation-at-birth
#16
Tai-Ho Hung, Ting-Xuan Huang, T'sang-T'ang Hsieh
OBJECTIVE: Difficulties often encountered during intubation in extremely low birth-weight (ELBW) neonates requiring resuscitation at birth because of the smaller airway and the pressure from the limited number of attempts before hemodynamic instability occurs. CASE REPORT: We evaluated two pregnant women at 26 weeks of gestation with premature rupture of membranes and evidence of chorioamnionitis and applied the concept of ex utero intrapartum treatment, which involved delaying cord clamping (DCC) after establishing a secured airway with adequate ventilation during cesarean delivery...
August 2017: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28583755/prognostic-significance-of-an-antenatal-magnetic-resonance-imaging-staging-system-on-airway-outcomes-of-fetal-craniofacial-venolymphatic-malformations
#17
David T Schindel, Diane Twickler, Natalie Frost, Deryk Walsh, Patricia Santiago-Munoz, Romaine Johnson
BACKGROUND: The aim of the article was to determine if anatomical findings on fetal magnetic resonance imaging (MRI) of venolymphatic malformations of the face and neck (VLMFN) can be used to create a staging system predictive of airway outcomes. METHODS: We reviewed 13 fetuses evaluated for VLMFN. Stage was assigned based on anatomical findings on fetal MRI. Stage I: no evidence of polyhydramnios with free egress of amniotic fluid and clear visualization of the aryepiglottic folds and larynx...
September 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28580573/fetal-neck-tumors-antenatal-and-intrapartum-management
#18
Jakub Kornacki, Jana Skrzypczak
In this review article we describe the ante- and perinatal management of fetal neck tumors. Although there are rare congenital anomalies, the clinical consequences for the fetus may be fatal and include airways obstruction, heart insufficiency, pulmonary hypoplasia and cosmetic effect. The right management allows to decrease the fetal and neonatal mortality and morbidity associated with the disease. It includes intrauterine therapy in some cases, mostly in a goitrus hypothyroidism of the fetus, but firstly, an assessment of the fetal airways patency with a subsequent, eventual Ex-Utero Intrapartum Treatment (EXIT)...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28578350/ex-utero-intrapartum-treatment-to-ventricular-pacing-a-novel-delivery-strategy-for-complete-atrioventricular-block-with-severe-bradycardia
#19
Bettina F Cuneo, Max B Mitchell, Ahmed I Marwan, Matthew Green, Johannes C von Alvensleben, Regina Reynolds, Timothy M Crombleholme, Henry L Galan
Fetuses with anti-SSA-mediated complete atrioventricular block (CAVB) are at high risk for perinatal death if they present at <20 weeks of gestation and develop ventricular rates of <55 beats per minute (bpm), cardiac dysfunction, or hydrops [Izmirly et al.: Circulation 2011;124:1927-1935; Jaeggi et al.: J Am Coll Cardiol 2002;39:130-137; Eliasson et al.: Circulation 2011;124:1919-1926]. After our experience with two such fetuses who died with pulseless electrical activity despite being paced within 30 min of birth, we performed an ex utero intrapartum treatment procedure to ventricular pacing on a 36-week CAVB fetus with cardiac dysfunction, mild hydrops, and a ventricular rate of 46 bpm...
2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28571898/-recommendations-for-respiratory-support-in-the-newborn-iv-high-frequency-ventilation-ex-utero-intrapartum-treatment-exit-extracorporeal-membrane-oxygenation-ecmo
#20
Félix Castillo Salinas, Dolores Elorza Fernández, Antonio Gutiérrez Laso, Julio Moreno Hernando, Gerardo Bustos Lozano, Manuel Gresa Muñoz, Xavier Miracle Echegoyen
The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into 12 modules, and in this work module 8 is presented. Each module is the result of a consensus process amongst all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, as well as the clinical experience of each one of the members of the group...
November 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
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