Techniques of Fetal Intervention What Is Fetal Intervention?
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Clinical Policy: Fetal Surgery in Utero for Prenatally Diagnosed
Clinical Policy: Fetal Surgery in Utero for Prenatally Diagnosed Malformations Reference Number: CP.MP.129 Effective Date: 01/18 Coding Implications Last Review Date: 09/18 Revision Log Description This policy describes the medical necessity requirements for performing fetal surgery. This becomes an option when it is predicted that the fetus will not live long enough to survive delivery or after birth. Therefore, surgical intervention during pregnancy on the fetus is meant to correct problems that would be too advanced to correct after birth. Policy/Criteria I. It is the policy of Pennsylvania Health and Wellness® (PHW) that in-utero fetal surgery (IUFS) is medically necessary for any of the following: A. Sacrococcygeal teratoma (SCT) associated with fetal hydrops related to high output heart failure : SCT resecton: B. Lower urinary tract obstruction without multiple fetal abnormalities or chromosomal abnormalities: urinary decompression via vesico-amniotic shunting C. Ccongenital pulmonary airway malformation (CPAM) and extralobar bronchopulmonary sequestration with hydrops (hydrops fetalis): resection of malformed pulmonary tissue, or placement of a thoraco-amniotic shunt; D. Twin-twin transfusion syndrome (TTTS): treatment approach is dependent on Quintero stage, maternal signs and symptoms, gestational age and the availability of requisite technical expertise and include either: 1. Amnioreduction; or 2. Fetoscopic laser ablation, with or without amnioreduction when member is between 16 and 26 weeks gestation; E. Twin-reversed-arterial-perfusion (TRAP): ablation of anastomotic vessels of the acardiac twin (laser, radiofrequency ablation); F. Myelomeningocele repair when all of the following criteria are met: 1. Singleton pregnancy; 2. Upper boundary of myelomeningocele located between T1 and S1; 3. -
Guide to Learning in Maternal-Fetal Medicine
GUIDE TO LEARNING IN MATERNAL-FETAL MEDICINE First in Women’s Health The Division of Maternal-Fetal Medicine of The American Board of Obstetrics and Gynecology, Inc. 2915 Vine Street Dallas, TX 75204 Direct questions to: ABOG Fellowship Department 214.871.1619 (Main Line) 214.721.7526 (Fellowship Line) 214.871.1943 (Fax) [email protected] www.abog.org Revised 4/2018 1 TABLE OF CONTENTS I. INTRODUCTION ........................................................................................................................ 3 II. DEFINITION OF A MATERNAL-FETAL MEDICINE SUBSPECIALIST .................................... 3 III. OBJECTIVES ............................................................................................................................ 3 IV. GENERAL CONSIDERATIONS ................................................................................................ 3 V. ENDOCRINOLOGY OF PREGNANCY ..................................................................................... 4 VI. PHYSIOLOGY ........................................................................................................................... 6 VII. BIOCHEMISTRY ........................................................................................................................ 9 VIII. PHARMACOLOGY .................................................................................................................... 9 IX. PATHOLOGY ......................................................................................................................... -
Journal of Surgery and Trauma
In the name of GOD Journal of Birjand University of Medical Surgery and trauma Sciences & Health Services 2345-4873ISSN 2015; Vol. 3; Supplement Issue 2 Publisher: Deputy Editor: Birjand University of Medical Sciences & Health Seyyed Amir Vejdan, Assistant Professor of General Services Surgery, Birjand University of Medical Sciences Director-in-Charge: Managing Editor: Ahmad Amouzeshi, Assistant Professor of General Zahra Amouzeshi, Instructor of Nursing, Birjand Surgery, Birjand University of Medical Sciences University of Medical Sciences Editor-in-Chief: Journal Expert: Mehran Hiradfar, Associate professor of pediatric Fahime Arabi Ayask, B.Sc. surgeon, Mashhad University of Medical Sciences Editorial Board Ahmad Amouzeshi: Assistant Professor of General Surgery, Birjand University of Medical Sciences, Birjand, Iran; Masoud Pezeshki Rad: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Taghizadeh kermani: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Jangjo: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Sayyed-zia-allah Haghi: Professor of Thoracic-Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Ramin Sadeghi: Assistant professor Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran; Mohsen Aliakbarian: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Mohammad Ghaemi: Assistant Professor -
Educational Exhibit Posters Chosen by the Annual Scientific Meeting
Educational Exhibit Posters Chosen by the Annual Scientific Meeting Committee In advance of the upcoming annual meeting of the Society of Interventional Radiology in Washington, DC, the program committee wishes to highlight the educational exhibit e-posters that will be presented. The posters were chosen using blinded review. Authors are congratulated for their contributions. Daniel Sze, MD, FSIR Chair, 2017 Annual Meeting Scientific Program Educational Exhibit e-Posters Abstract No. 581 Etiology Technique Used Hepatic artery pseudoaneurysms: a pictorial review of Trauma Falling injury Gelfoam with intraprocedural different scenarios and managements cone-beam 3D CT imaging R. Galuppo Monticelli1, Q. Han1, G. Gabriel1, S. Krohmer1, D. Raissi1 Gunshot injury Coiling Iatrogenic Post cholecystectomy Onyx embolization 1University of Kentucky, Lexington, KY Post biliary drain Coiling PURPOSE: The focus of this educational exhibit is to present a pictorial placement review of the anatomical considerations and management in varied Post ERCP Gelfoam cases of hepatic artery pseudoaneurysms (HAPs) secondary to differ- Tumor Hemorrhage Embozene ent etiologies. Special attention is given to troubleshooting HAPs with Tumor related Post TACE N-Butyl cyanoacrylate varied anatomical presentations. Transplant related Portal hypertension iCAST covered Stent MATERIALS: Hepatic artery pseudoaneurysm (HAP) is an unusual but Idiopathic Otherwise healthy male Coiling with sandwich technique serious complication of acute or chronic injury to the hepatic artery that can potentially be fatal. HAPs are classified as intrahepatic or extrahe- patic. There are many etiologies of HAP formation, including trauma, iat- Abstract No. 582 rogenic, tumor, pancreatitis, inflammatory and idiopathic. Early detection Stenting as a first-line therapy for symptomatic and treatment is critical to decrease morbidity and mortality. -
(EXIT), a Resuscitation Option for Intra-Thoracic Foetal Pathologies
Original article SWISS MED WKLY 2007;137:279–285 · www.smw.ch 279 Peer reviewed article Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies Christian Kerna, Michel Ange, Moralesb, Barbara Peiryc, Riccardo E. Pfisterc a Anaesthesia, University Hospital Geneva, Switzerland b Gynaecology and Obstetrics, University Hospital Geneva, Switzerland c Paediatrics, University Hospital Geneva, Switzerland Summary The ex utero intrapartum treatment (EXIT) requires a caesarean section that specifically differs procedure is designed to guarantee sufficient oxy- from the traditional caesarean section during genation for a foetus at risk of airway obstruction. which uterine tone is maintained to minimize ma- This is achieved by improving lung ventilation, ternal bleeding. To guarantee foetal oxygenation usually by establishing an airway during caesarean during the EXIT procedure, profound uterine delivery whilst preserving the foetal-placental cir- relaxation is desired. To gain time with optimal culation temporarily. Indications for the EXIT placental oxygenation in order to safely perform an procedure have extended from its original use in airway intervention in a baby at risk of hypoxia may reversing iatrogenic tracheal obstruction in con- require deep inhalation anaesthesia and/or to- genital diaphragmatic hernia to naturally occur- colytic agents. We review the EXIT procedure and ring upper airway obstructions. We report our present a case series from the University Hospital experience with a new and rarely mentioned indi- of Geneva that contrasts with the common indica- cation for the EXIT procedure, intra-thoracic tion for the EXIT procedure usually based on volume expansions. The elaboration of lowest risk upper airway obstruction by its exclusive indica- scenarios through balancing risks with alternative tion for intra-thoracic malformations/diseases. -
00I-Iv Sieog Linee Guida 2010-2.Pmd
I LINEE GUIDA SIEOG Società Italiana di Ecografia Ostetrico Ginecologica Edizione 2010 SIEOG II SIEOG Società Italiana di Ecografia Ostetrico Ginecologica e Metodologie Biofisiche Segreteria permanente e tesoreria: Via dei Soldati, 25 - 00186 ROMA - Tel. 06.6875119 - Fax 06.6868142 [email protected] - www.sieog.it - C/C postale N. 20857009 CONSIGLIO DIRETTIVO 2008-2010 PRESIDENTE Paolo Volpe (Bari) PAST-PRESIDENT Tullia Todros (Torino) VICEPRESIDENTI Clara Sacchini (Parma) Antonia Testa (Roma) CONSIGLIERI Carolina Axiana (Cagliari) Elisabetta Coccia (Firenze) Lucia Lo Presti (Catania) Simona Melazzini (Udine) Giuliana Simonazzi (Bologna) TESORIERE Cinzia Taramanni (Roma) SEGRETARIO Valentina De Robertis (Bari) Copyright © 2010 ISBN: 88-6135-124-7 978-88-6135-124-0 Via Gennari 81, 44042 Cento (FE) Tel. 051.904181/903368 Fax 051.903368 www.editeam.it [email protected] Progetto Grafico: EDITEAM Gruppo Editoriale Tutti i diritti sono riservati. Nessuna parte di questa pubblicazione può essere riprodotta, trasmessa o memorizzata in qualsiasi forma e con qualsiasi mezzo senza il permesso scritto dell’Editore. Finito di stampare nel mese di Ottobre 2010. LETTERA AI SOCI III Cari Soci, come da impegno preso per iscritto negli anni precedenti che cadenzava l’aggiornamento delle Linee Guida SIEOG ad un intervallo di 3 anni, allo scadere del mandato di questo Consiglio di Presidenza (CDP) presentiamo la revisione delle LG SIEOG. Sono state realizzate in sintonia con il lavoro dei colleghi dei CDP che ci hanno preceduto e che ha portato alla pubblicazione delle precedenti LG nel 1996, 2002 e 2006. Sono espressione della continua evoluzione scientifica e tecnologica nel nostro settore nonché del ruolo importante, che dal punto di vista clinico, la metodica ecografica ha raggiunto nella nostra disciplina. -
The EXIT (Ex-Utero Intrapartum Treatment) Procedure
ACTA OTORHINOLARYNGOLOGICA ITALICA 2018;38:480-484; doi: 10.14639/0392-100X-1261 OPEN ACCESS Case series and reports The EXIT (ex-utero intrapartum treatment) procedure – from the paediatric ENT perspective Procedura EXIT (ex-utero intrapartum treatment) – prospettive otorinolaringoiatriche pediatriche B. PUCHER1, J. SZYDLOWSKI1, K. JONCZYK-POTOCZNA2, J. SROCZYNSKI1 1 Department of Paediatric Otolaryngology, Poznan University of Medical Sciences; 2 Department of Paediatric Radiology, Poznan University of Medical Sciences, Poland SUMMARY The main principle of the EXIT procedure is to maintain uteroplacental circulation with neonatal anaesthesia by controlled uterine hypoto- nia. 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. Two newborns died shortly af- ter the EXIT procedure. The EXIT procedure allows the paediatric otolaryngologist to provide airway patency of newborns during delivery. Both ultrasound and MR imaging are crucial in the prenatal assessment of foetal head and neck masses. Their application in the evaluation of any foetal anomaly is essential for proper prognosis and treatment. Maternal monitoring for complications such as polyhydramnios and preterm labour are important in planning and desirability of the EXIT procedure. KEY WORDS: EXIT procedure • Foetal neck masses • Foetal airways • Prenatal imaging • Teratoma • Lymphatic malformation RIASSUNTO L’obiettivo principale della procedura EXIT è sfruttare la circolazione uteroplacentare inducendo una anestesia nel neonato e controllan- do l’ipotonia uterina. -
Safe Surgery Checklist in an EXIT Procedure for a Foetus with a Giant Neck Mass
Safe surgery checklist in an EXIT procedure for a foetus with a giant neck mass. Centro Policlinico del Olaya (CPO)-Bogotá, Colombia G. Reyes1, R. Duque2, C. Rojas3, A. Romero4, B. Narvaez5, R. Herrera6 1. Maternal Fetal Medicine Consultant e-mail: [email protected]. 2. Obstetrics and gynaecology Consultant. 3. Neonatology Consultant. 4. Anaesthesiology Consultant. 5. Paediatric Surgery Consultant. 6. Scientific Director of CPO INTRODUCTION The ex utero intrapartum treatment (EXIT) is procedure for maintaining utero-placental circulation during caesarean section to guaranty new-born air way in a potentially obstructed fetal airway1,2. The EXIT procedure is an elective caesarean section, which the foetus is only partially delivered from the uterus with maintenance of the utero-placental circulation allowing for diagnostic and/or therapeutic procedures to the fetal airway. The foetus has been anesthetized and when the airway is secured the foetus is delivered and the umbilical cord clamped. A complete uterine relaxation by deep volatile anaesthesia in needed and uterine volume must be preserved by the foetus and warmed Ringer’s lactate solution infused into the uterine cavity1,3,4,5 . In order to maintain the uteroplacental blood flow, maternal cardiac output and blood pressure have to be kept at acceptable levels6,7. Main prerequisites during the EXIT procedure include a multidisciplinary coordinated team so we applied the WHO criteria and a check list was performed8,9. We organized a preliminary drill to prepare the final EXIT. Finally, the EXIT was performed including a team of 20 people inside the operating theater. CASE A 25-year-old primigravida patient, at 22 weeks during the anomaly scan has been detected a 60 mm foetal neck cystic mass in the left side. -
UWOMJ Volume 74, No. 1 Western University
Western University Scholarship@Western University of Western Ontario Medical Journal Digitized Special Collections 2005 UWOMJ Volume 74, No. 1 Western University Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons Recommended Citation Western University, "UWOMJ Volume 74, No. 1" (2005). University of Western Ontario Medical Journal. 5. https://ir.lib.uwo.ca/uwomj/5 This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected]. Paediatrics London Health Sciences Centre 800 Cmnmissioners Road East London, ON N6A 405 v Canada's Trusted Choice Adverse Reactions Advene Drug Reection Overview MoA Common Adotetu Eft.cts I lodJ Syrtem I Clmetldlne (--.) ~D ('Mt) I<NS 1hood•"'• r-z.1-' ·' !Endocrtne end Het.bollsm - I I GJnecomerti• r- 0.3-4,0 I N/A [CedTolnt .. cttn•l - Wffi. Current drug information <•• ~~~~ at your fingertips! • Instant access to approximately 3000 Health-Canada-approved product monographs Updated and always current Search products by brand name, generic name and/or therapeutic class CANADLAN PHARMACISTS Search directories for Canada's poison control centres, various health organizations, ASSOCIATION manufacturers and distributors of pharmaceutical products ASSOCIATION DES PHARMACIENS DUCANADA • Printable, easy-to-read "Information for the Patient" leaflets - now the only resource offering these customer-friendly pages Subscribe online at www.e-cps.ca OMJ Volume 74 Number 1 Contents EDITORIAL Health Promotion Changes A Review of Current Literature on NuvaRing , Leanne Tran, Editor-in-Chief 3 a Contraceptive Vaginal Ring DEPARTMENT ARTICLES Michelle Ngo, B.Sc. -
Curriculum for Subspecialty Training in Maternal and Fetal Medicine
Maternal and Fetal Medicine Curriculum Curriculum for Subspecialty Training in Maternal and Fetal Medicine Module 1 Medical Complications of Pregnancy Module 2 Genetics Module 3 Structural Fetal Abnormalities Module 4 Antenatal Complications Module 5 Intrapartum Complications Module 6 Infectious Diseases 1 Last updated February 2013 Maternal and Fetal Medicine Curriculum Module 1 Medical complications of pregnancy 1.1 Hypertension Objectives Manage a case of chronic hypertension, including: Counsel regarding fetal and maternal risks 1. To be able to carry out appropriate assessment (including long-term health implications. and management of women with chronic hypertension. Arrange appropriate investigations. 2. To be able to carry out appropriate assessment institute and modify drug therapy. and management of women with pregnancy- Plan delivery and postnatal care. induced hypertension, pre-eclampsia and Refer, where appropriate, for further assessment associated complications. and treatment. Chronic hypertension Professional skills and attitudes Knowledge criteria Ability to take an appropriate history and conduct an examination to screen for secondary causes and Definition and diagnosis: complications of chronic hypertension. Measurement of blood pressure in pregnancy, including validated devices. Ability to perform and interpret appropriate Impact of pregnancy on blood pressure. investigations. Superimposed pre-eclampsia. Prevalence (primary and secondary causes). Ability to formulate, implement and, where appropriate, modify a multidisciplinary management Pathophysiology: plan. Acute hypertension. Chronic hypertension (including end-organ Ability to manage antihypertensive drug therapy in damage). antenatal and postnatal periods. Management: Ability to liaise with primary care and physicians in Screening for common causes of secondary management of hypertension. hypertension. Ability to counsel women about: Pregnancy management, including fetal monitoring. -
Anesthesia for Ex Utero Intrapartum Treatment (EXIT Procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports
Rev Bras Anestesiol CLINICAL INFORMATION 2012; 62: 3: 411-423 CLINICAL INFORMATION Anesthesia for Ex Utero Intrapartum Treatment (EXIT procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports Daniel Corrêa Helfer 1, Jefferson Clivatti 2, Américo Massafuni Yamashita, TSA 3, Antonio Fernades Moron 4 Abstract: Helfer DC, Clivatti J, Yamashita AM, Moron AF – Anesthesia for Ex Utero Intrapartum Treatment (EXIT procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports. Background and objectives: Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant’s delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured. Case Reports: Female patient, 37 years old, G3P2, 38 weeks pregnant, having polyhydramnios and fetus diagnosed with large cervical masses by prenatal ultrasound. A cesarean section was performed using the EXIT procedure to enable safe access to the infant’s airways. After hystero- tomy, the fetus was intubated by direct laryngoscopy. The neonate was immediately transferred to another operating room, where cervical tumor resection of the neck tumor and tracheostomy were successfully performed. Female patient, 27 years old, G3P1A1, 32 weeks pregnant, whose fetus was prenatally diagnosed with a large oral tumor. -
Anaesthesia for Fetal Surgery
Anaesthesia for fetal surgery Dr.M.Păpurică, Dr.O.Bedreag UMF”V.Babes” Timișoara History of fetal surgery 1965 - first intrauterine transfusion for hydrops due to Rh incompatibility by A.W.Liley 1974 - fetoscopy to obtain fetal samples by Hobbin 1981- fetoscopic transfusion by Rodeck 1982 - first open fetal surgery for obstructive uropathy by Dr. Michael Harrison, University of California, San Francisco What is fetal surgery? It is application of established surgical techniques to the unborn baby - during gestation - at the time of delivery fetal intervention is reaching inside the uterus many diseases can now be accurately diagnosed before birth by genetic and imaging techniques maternal - fetal intervention the safety of the mother Contraindication for fetal surgery conditions incompatible with life chromosomal and genetic disorders other associated life threatening abnormalities usually performed between 24-29 weeks gestation Requires combined expertise of Obstetrician Anaesthesiologist Neonatologist Pediatric surgeon Indications For Fetal Surgery 1. Anatomic lesions that interfere with development: - Bilateral obstructive hydronephrosis or lower urinary tract obstruction - Obstructive hydrocephalus - Congenital diaphragmatic hernia(CDH) - Cardiac anomalies-complete heart block, AS, PS - Neural tube defects –spina bifida, sacrococcygeal teratoma, myelomeningocele - Skeletal defects - Gastroschisis - Thoracic space occupying lesions - Giant neck masses - Tracheal atresia-stenosis - Congenital cystic pulmonary adenomatoid