OPERATING ON PLACENTAL SUPPORT - THE EX-UTERO INTRAPARTUM TREATMENT PROCEDURE

While treating eight fetuses with predictable airway obstruction, the authors developed a systematic approach, the ex utero intrapartum trea tment procedure, to secure the airway during delivery Six patients had their trachea plugged or clipped in utero for treatment of congenital diaphragmatic hernia, and two patients had prenatally diagnosed cysti c hygroma of the neck and oropharynx. The ex utero intrapartum treatme nt procedure was performed by using high doses of inhaled halogenated agents to facilitate uterine relaxation during cesarean section, secur ing the fetal airway while fete-placental circulation remained intact, and then dividing the umbilical cord. A variety of procedures were pe rformed during the ex utero intrapartum treatment procedure including bronchoscopy, orotracheal intubation, tracheostomy, tracheostomy with retrograde orotracheal intubation,tracheoplasty, removal of internal t racheal plug, removal of external tracheal clip, central line placemen t, and instillation of surfactant. There were minimal maternal or feta l complications during the procedure. This approach requires the coord inated efforts of pediatric surgeons, obstetricians, anesthesiologists , sonographers, and neonatologists. The combination of intensive mater nal-fetal monitoring, cesarean section with maximal uterine relaxation , and maintenance of intact fete-placental circulation provides a cont rolled environment for securing the airway in babies with prenatally d iagnosed airway obstruction. Copyright (C) 1997 by W.B. Saunders Compa ny.