Intrapartum management of severe fetal airway obstruction

Department of Pediatric Otolaryngology, 3333 Burnet Avenue, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
The Journal of otolaryngology (Impact Factor: 0.5). 11/2004; 33(5):283-8. DOI: 10.2310/7070.2004.03084
Source: PubMed

ABSTRACT To review our experience with the planned intrapartum management of fetuses with suspected severe airway obstruction.
Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications.
All cases (N = 11) at our tertiary airway referral institution between 1995 and 2002 were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases.
Although full cesarean delivery of the fetus significantly reduces fetal-placental circulation times, in comparison with the formal ex utero intrapartum treatment (EXIT) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To present our experience in the perinatal management of fetuses with large oropharyngeal tumors by ex utero intrapartum treatment (EXIT). We performed a retrospective chart review of all patients with congenital oropharyngeal tumor who underwent an EXIT procedure between May 2006 and June 2012. Four patients were included in the series, three females and one male. The diagnoses were epignathus (n=2) and congenital epulis (n=2). Three EXITs were done at term and one at late preterm due to premature rupture of membranes. Median maternal time under anesthesia was 185min (range: 166-281) and median maternal operative time was 99min (range: 85-153). Median maternal blood loss was 550ml (range: 350-2000); one mother required a blood transfusion. Mean maternal hospital stay was 4days. Median hysterotomy-to-cord clamp time was 24min (range: 18-66). Mean fetal birth weight was 2.7kg (range: 2.4-3). The airway was successfully accessed and secured under placental circulation in all cases. In the two patients with congenital epulis the tumors were resected at the base of their pedicles and the airway accessed via direct laryngoscopy before the umbilical cord was clamped. One patient with epignathus underwent a retrograde tracheal intubation under placental circulation and had the tumor resected thereafter. The second patient with epignathus had a tracheostomy done under placental circulation and then had tumor debulking immediately after the EXIT. The maternal morbidity was minimal and there were no mortalities. We conclude that the EXIT procedure is the ideal delivery strategy for fetuses with prenatally diagnosed oropharyngeal tumors and potential airway obstruction at birth. Patients with prenatally diagnosed oropharyngeal tumors should be promptly referred to a fetal treatment center with a dedicated multidisciplinary team and EXIT capabilities.
    Journal of Pediatric Surgery 10/2013; 48(10):2005-2010. DOI:10.1016/j.jpedsurg.2013.02.031 · 1.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the paediatric and maternal outcome after ex utero intrapartum treatment (EXIT). A retrospective review was carried out of the medical charts (gestational age, circumstances of diagnosis, multidisciplinary prenatal decision, date of surgery, paediatric and maternal outcome) of all the fetuses eligible for/delivered via the EXIT procedure in our paediatrics and obstetrics tertiary care and teaching centre, between October 2004 and May 2011. Seven fetuses with cervical teratoma, epignathus tumour or congenital high airway obstruction syndrome (CHAOS) were included in our study. Two pregnancies were terminated and five fetuses were delivered alive. The airway was secured in all five cases (two endotracheal intubations and three tracheostomies). No maternal complications were observed. On average, babies were delivered at 32 gestational weeks, and spent 31 days in the intensive care unit. All but one baby were ventilated for 18 days. Long-term paediatric outcome was favourable. It is concluded that airway management by the EXIT procedure has become an efficient technique. A multidisciplinary prenatal assessment is essential in order to select appropriate cases.
    Journal of Obstetrics and Gynaecology 11/2013; 33(8):787-94. DOI:10.3109/01443615.2013.823924 · 0.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: An experimental investigation into the microstructure, mechanical properties and aging behaviors of as-extruded Mg–5Li–3Al–2Zn–1.5Cu alloy is conducted. The results show that, during the hot extrusion process, the large bulk intermetallic compounds (AlLi, AlCuMg and Al2Cu phases) of as-cast alloy are crushed into small bulk compounds. The dynamic recrystallization (DRX) takes place, which results in the refinement of grains significantly. A fibrous type texture of (0002) basal plane is formed through the hot extrusion. Tensile tests reveal that the mechanical properties of the alloy are greatly improved after the hot extrusion. Due to the continuous and discontinuous precipitations of AlLi phases, the as-extruded alloy presents age hardening effect at the aging time of 14h and 48h, respectively.
    Materials Science and Engineering A 04/2011; 528(10):3915-3920. DOI:10.1016/j.msea.2011.01.025 · 2.41 Impact Factor