Flashcards in Week 2 Anesthesia for Fetal Surgery (everything) Deck (69)
Fetal surgical therapy orignated in 1963 by
Dr Liley - successful performance of intraperitoneal blood transfusion to a fetus w/ erythroblastosis fetalis
ertythroblastosis fetalis is
a hemolytic anemia in the fetus caused by transplacental transmission of maternal antibodies to fetal RBC's
an opening created by the surgeon b/w the abd wall and the bladder
Box 7.1 Guidelines for Performing Fetal Procedures:
All of these must be met to perform a fetal procedure
(all included just for reference)
(Box 7.1 )Guidelines for Performing Fetal Procedures
1.Accurate diagnosis and staging is possible.
2.Other anomalies that would contraindicate fetal intervention are excluded.
3.Progression, severity, and prognosis of the condition are understood.
4.No effective postnatal therapy is currently available, and if not treated before birth, the anomaly would result in fetal death, irreversible organ damage, or other severe postnatal morbidity.
5.Intrauterine surgery has been proven feasible in animal models, with demonstrated reversal of the deleterious effects of the condition.
6.The maternal risk is acceptably low.
7.Interventions are performed in specialized multidisciplinary fetal treatment centers within strict protocols and approval of the local ethics committee, with informed consent obtained from the mother or parents.
8.There is access to high-level specialized medical care, including bioethical and psychosocial care and counseling.
*** Most correctable malformations are best managed
Indicators and Clinical Rationale for fetal surgery include:
1. Obstructive Uropathy
2. Congenital Diaphragmatic Hernia
3. Congenital Pulmonary Airway Malformations
4. Fetal Anemia and Intrauterine Transfusion
5. Sacrococcygeal Teratoma
7. Twin-to-Twin Transfusion Syndrome
8. Twin Reversed Arterial Perfusion Sequence
9. Congenital Heart Defects
Intrauterine Transfusion may be indicated when
a fetus has anemia (low RBC count)
*Fetal anemia caused by:
Rh incompatibility (mother and fetus have different blood types; the antibodies in the mother's blood may destroy blood cells in the fetus)
Intrauterine transfusions are performed using
20-22g needle w/ local anesthesia at site of needle insertion
Where is the needle inserted for an IUT?
percutaneously through the maternal abd and uterus under US guidance
For IUT, where does the transfusion occur?
Following an IUT, fetal Hgb levels
and multiple IUTs are often required at 1-3 week intervals
Obstructive Uropathy is a condition in which
the flow of urine is blocked.
-causes the urine to back up and cause injury to one or both kidneys
Lower urinary tract obstruction (LUTO) occurs in approx how many births?
** congenital bilateral hydronephrosis results from
fetal urethra obstruction
excess fluid in the kidney
Other causes of Fetal OU include:
obstruction of the uteropelvic junction or vesicoureteric junction
**and a number of other disorders in females
**What are the tx for fetal OU?
-placement of a vesicoamniotic shunt (VAS shunt)
What does a vesicoamniotic shunt (VAS) do?
allow drainage of urine from the fetal bladder
** This occurs when the diaphragm, the muscle that separates the chest from the abdomen, fails to close during prenatal development. This opening allows contents of the abdomen (stomach, intestines and/or liver) to migrate into the chest, impacting the growth and development of the lungs
Congenital diaphragmatic hernia (CDH)
**A diaphragmatic hernia is a
life-threatening illness and requires care in a neonatal intensive care unit (NICU).
** because their lungs are underdeveloped, babies with a diaphragmatic hernia are often unable
to breathe effectively on their own
What prenatal exam can detect CDH and alert PCP that further evaluation by a high volume fetal center is warranted?
** is a birth defect in which the backbone and spinal canal do not close before birth.
** Myelomeningocele is a type of ____ . What is the cause?
The condition is a type of spina bifida the cause is unknown.
Purpose of in utero surgery for Myelomeningocele
is to improve function later in life
the leading cause of mortality from birth defects
Congenital heart abnormalities and occur in approximately 1% of live births
Congenital heart abnormalities and occur in approximately %?
approximately 1% of live births
the most common minimally invasive intervention performed for a congenital heart defect.
Fetal valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome is