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Ex utero intrapartum treatment

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https://www.readbyqxmd.com/read/28580573/fetal-neck-tumors-antenatal-and-intrapartum-management
#1
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
#2
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...
June 3, 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
#3
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...
May 29, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28524841/ex-utero-intrapartum-treatment-for-the-pericardial-effusion-drain-of-a-fetal-cardiac-tumor
#4
Jian Zhuang, Wei Pan, Cheng-Bin Zhou, Feng-Zhen Han
No abstract text is available yet for this article.
June 5, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28483254/teratoma-of-the-neonatal-head-and-neck-a-41-year-experience
#5
Jacob R Brodsky, Alexandria L Irace, Amanda Didas, Karen Watters, Judy A Estroff, Carol E Barnewolt, Antonio Perez-Atayde, Reza Rahbar
OBJECTIVE: To review our institution's experience with the presentation, evaluation, and management of teratoma of the head and neck in the neonatal population. DESIGN: Retrospective case series (November 1970 through September 2011). SETTING: Tertiary care children's hospital. PATIENTS: 14 patients (12 boys and 2 girls). INTERVENTION: Detailed review of presentation, diagnostic approaches, surgical management, and outcomes...
June 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28365065/infantile-hemangiopericytoma-of-the-tongue-efficacy-of-ex-utero-intrapartum-treatment-procedure-and-combined-modality-therapy
#6
Takenori Ogawa, Ryo Ishii, Daiki Ozawa, Takeshi Rikiishi, Hajime Usubuchi, Mika Watanabe, Yoshimichi Imai, Kenichi Sato, Masatoshi Saito, Yoji Sasahara, Tadashi Matsuda, Shigeo Kure, Yukio Katori
Here we present an extremely rare case of giant infantile hemangiopericytoma (HPC) of the tongue diagnosed prenatally by fetal ultrasonography and MR imaging. Due to airway stenosis, the patient was delivered by the ex utero intrapartum treatment (EXIT) procedure at 36 weeks of pregnancy. Initial diagnosis was infantile hemangioma based on physical examination, diagnostic imaging and the high incidence of hemangioma. The tumor was resistant to conservative treatments. Due to severe tumor hemorrhage, the nutrient vessel was embolized by endovascular treatment on the 73th day after birth...
March 29, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/28343178/fetal-cardiac-tumors-clinical-features-management-and-prognosis
#7
Shi-Min Yuan
Fetal cardiac tumors are rare and usually benign. While echocardiography is a reliable technique for diagnosing fetal cardiac tumors, their definitive diagnosis relies on pathological examination. The strategies used to manage fetal cardiac tumors are challenging. A good clinical result is their complete regression during pregnancy or shortly after birth, as often occurs with cardiac rhabdomyomas. Moreover, the fetal prognosis depends on the nature of the tumors, namely, their location, size, number and associated complications...
March 27, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28301889/geburtshilfe-an%C3%A3-sthesie-bei-exit-prozedur
#8
Alexander Torossian
The ex utero intrapartum treatment (EXIT) procedure is performed as a part of an extended caesarean section for example to treat fetal airway disorders. For treatment, optimal uterine relaxation is necessary, however utero-placental supply of the fetus has to be guaranteed as well. "Balanced" anesthesia, tocolysis and tight maternal arterial blood pressure control are recommended. Standard fetal monitoring comprises pulse oxymetry and echocardiography. The article describes the physiology and anesthestic goals of the EXIT procedure, discusses alternative anesthesia techniques and gives an outlook on emerging progress...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28275857/influence-of-maternal-remifentanil-concentration-on-fetal-to-maternal-ratio-in-pregnant-ewes
#9
Masaki Sato, Kenichi Masui, Borjigin Sarentonglaga, Mio Yamaguchi, Rika Fukumori, Yoshikazu Nagao, Haruhiko Sago, Hiroyuki Sumikura
PURPOSE: Maternal remifentanil infusion is used for minimally invasive fetal surgery or ex-utero intrapartum treatment. The fetal-to-maternal (F/M) ratio of remifentanil concentration at various dosing regimens is useful to manage remifentanil effects. The aim of this study was to investigate the F/M ratio of remifentanil at various concentrations. METHODS: Five pregnant ewes received continuous remifentanil infusion under propofol anesthesia. The remifentanil infusion rate was increased by 0...
March 8, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28267705/ex-utero-intrapartum-treatment-exit-for-upper-airway-obstruction
#10
Colin R Butler, Elizabeth F Maughan, Pranav Pandya, Richard Hewitt
PURPOSE OF REVIEW: Improvements in the antenatal diagnosis of congenital malformations have led to increased detection of fetal airway obstructing lesions, and pediatric ear, nose, and throat surgeons are increasingly involved in these cases. RECENT FINDINGS: This article outlines the typical range of pathology seen, the logistics in providing support for anticipated deliveries and the multidisciplinary management of complex airway cases. SUMMARY: Traditionally, difficulty in obtaining a patent airway at delivery was a major factor in the dismal prognosis of these pregnancies...
April 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28211140/anesthesia-for-fetal-surgery
#11
REVIEW
Monica A Hoagland, Debnath Chatterjee
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended...
April 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28122111/obstructing-in-utero-oropharyngeal-mass-case-report-of-a-lymphatic-malformation-arising-within-an-oropharyngeal-teratoma
#12
Todd J Wannemuehler, Christopher R Deig, Brandon P Brown, Stuart A Morgenstein
An ex utero intrapartum treatment procedure was performed to deliver a fetus with a multiseptated, entirely cystic, 4.5 × 5.0 × 4.0-cm mass occupying the oropharynx and oral cavity with protrusion from the mouth. Surgical excision was performed, and final pathologic diagnosis revealed a lymphatic malformation arising within a cystic oropharyngeal teratoma. Lymphatic malformations are virtually indistinguishable radiologically from rare, purely cystic teratomata, and efforts have been made to distinguish between the two in utero because of differing available treatment modalities...
January 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/27926636/feasibility-and-outcomes-of-fetoscopic-tracheal-occlusion-for-severe-left-diaphragmatic-hernia
#13
COMPARATIVE STUDY
Michael A Belfort, Oluyinka O Olutoye, Darrell L Cass, Olutoyin A Olutoye, Christopher I Cassady, Amy R Mehollin-Ray, Alireza A Shamshirsaz, Stephanie M Cruz, Timothy C Lee, David G Mann, Jimmy Espinoza, Stephen E Welty, Caraciolo J Fernandes, Rodrigo Ruano
OBJECTIVE: To evaluate feasibility and initial outcomes of fetoscopic tracheal occlusion for severe diaphragmatic hernia compared with a historical cohort who had not received fetal tracheal occlusion. METHODS: Outcomes in a prospective observational cohort who underwent fetoscopic tracheal occlusion for severe fetal left diaphragmatic hernia without associated anomalies were compared with our historical nontreated cohort of matched fetuses of similar severity. Fetuses were classified using the same ultrasonography and magnetic resonance imaging methodology-prospectively in the fetoscopic tracheal occlusion group and retrospectively in the historical nontreated cohort...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27836357/does-the-ex-utero-intrapartum-treatment-to-extracorporeal-membrane-oxygenation-procedure-change-morbidity-outcomes-for-high-risk-congenital-diaphragmatic-hernia-survivors
#14
Hester F Shieh, Jay M Wilson, Catherine A Sheils, C Jason Smithers, Virginia S Kharasch, Ronald E Becker, Mollie Studley, Donna Morash, Terry L Buchmiller
PURPOSE: In high-risk congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before extracorporeal membrane oxygenation (ECMO) can be initiated. We previously examined ex utero intrapartum treatment (EXIT)-to-ECMO in our most severe CDH patients, but demonstrated no survival advantage. We now report morbidity outcomes in survivors of this high-risk cohort to determine whether EXIT-to-ECMO conferred any benefit. METHODS: All CDH survivors with <15% predicted lung volume (PPLV) from September 1999 to December 2010 were included...
January 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#15
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27645029/ep21-23-ex-utero-intrapartum-treatment-exit-procedure-for-cervical-teratoma
#16
K Maeda, D Nakaoku, M Murakami, A Kondo, M Morine, K Hinokio, T Kaji
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27530489/fetal-intrapericardial-teratoma-natural-history-and-management-including-successful-in-utero-surgery
#17
Jack Rychik, Nahla Khalek, J William Gaynor, Mark P Johnson, N Scott Adzick, Alan W Flake, Holly L Hedrick
BACKGROUND: Intrapericardial teratoma is a rare, lethal tumor often detected in fetal life. Tumor mass and pericardial effusion cause cardiac tamponade that, if relieved, could be life-saving. Optimal timing of intervention and methods for effective fetal treatment are unknown. OBJECTIVE: We describe our single-center experience with fetal intrapericardial teratoma including the first report of successful in utero surgical resection with survival to term. STUDY DESIGN: We reviewed our database for suspected fetal intrapericardial teratoma...
December 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27508950/prenatally-diagnosed-fetal-tumors-of-the-head-and-neck-a-systematic-review-with-antenatal-and-postnatal-outcomes-over-the-past-20-years
#18
Gabriele Tonni, Roberta Granese, Eduardo Félix Martins Santana, José Pedro Parise Filho, Isabela Bottura, Alberto Borges Peixoto, Annamaria Giacobbe, Andrea Azzerboni, Edward Araujo Júnior
AIM: The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. METHODS: PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. RESULTS: A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility...
February 1, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/27468407/management-of-giant-cervical-teratoma-with-intracranial-extension-diagnosed-in-utero
#19
Jayesh P Thawani, Michael J Randazzo, Nickpreet Singh, Jared M Pisapia, Kalil G Abdullah, Phillip B Storm
Cervical teratomas are rare germ cell tumors affecting the fetus that are associated with significant morbidity and mortality due to an increased risk of airway obstruction at delivery. These tumors can commonly produce polyhydramnios that results from the fetus' impaired ability to swallow amniotic fluid. Improved rates of prenatal diagnosis through comprehensive evaluations and imaging have dramatically impacted the perinatal management of infants with this condition. Here, we report a patient diagnosed with polyhydramnios whose fetus was discovered to have a giant cervical teratoma on imaging studies...
July 2016: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/27298534/chaos
#20
Aman Gupta, Chandrajeet Yadav, Sandeep Dhruw, Divyangi Mishra, Abhijeet Taori
INTRODUCTION: Congenital high airway obstruction syndrome (CHAOS) is a rare, usually lethal abnormality characterized by complete or near-complete intrinsic obstruction of the fetal airway. Laryngeal atresia is the most frequent cause, but other etiologies include laryngeal or tracheal webs, laryngeal cyst, subglottic stenosis or atresia, tracheal atresia and laryngeal or tracheal agenesis. When antenatal diagnosis of possible upper airway obstruction is made, specific type of obstruction is rarely determined making the term CHAOS introduced by Hedrick et al in 1994 more appropriate...
June 2016: Journal of Obstetrics and Gynaecology of India
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