Document Detail

Impact of continuous intraoperative monitoring on outcomes in open fetal surgery.
MedLine Citation:
PMID:  15980648     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: There are shifts in fetal hemodynamics during open fetal surgery that were not appreciated until the use of intraoperative fetal echocardiography. We have developed an intraoperative monitoring strategy to continuously assess fetal hemodynamics. We hypothesized that this approach would enhance intraoperative management and survival. METHODS: Medical records of open fetal surgery patients were reviewed since the implementation of this approach. Intraoperative fetal monitoring was accomplished by continuous echocardiography, pulse oximetry, establishment of intravenous access, and arterial blood gas and hemoglobin measurement. Overall survival was compared to fetal surgeries performed prior implementation of this monitoring strategy. RESULTS: Resections of a congenital cystic adenomatoid malformation or a sacrococcygeal teratoma in nine hydropic fetuses were performed while using this monitoring strategy. Intraoperative echocardiography resulted in a change of management in 7 of 9 fetuses. The main observations on fetal echocardiography resulting in intraoperative intervention were decreased ventricular filling, bradycardia, and decreased ventricular contractility. Therapy included administration of volume expanders and/or inotropic agents. Overall fetal survival was 78% compared to a survival of 42% prior to the implementation of this approach. CONCLUSION: Continuous intraoperative fetal monitoring provides real time assessment of fetal hemodynamics which results in changes in intraoperative management. The overall outcomes in these critically ill fetuses have been improved.
Sundeep G Keswani; Timothy M Crombleholme; Jack Rychik; Zhiyun Tian; Tippi C Mackenzie; Mark P Johnson; R Douglas Wilson; Alan W Flake; Holly L Hedrick; Lori J Howell; N Scott Adzick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  20     ISSN:  1015-3837     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:    2005 Jul-Aug
Date Detail:
Created Date:  2005-06-27     Completed Date:  2005-09-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  316-20     Citation Subset:  IM    
Copyright Information:
(c) 2005 S. Karger AG, Basel
Center for Fetal Diagnosis and Treatment and Fetal Heart Program at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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MeSH Terms
Fetal Death
Fetal Diseases / mortality,  surgery*,  ultrasonography*
Intraoperative Complications / prevention & control*
Monitoring, Intraoperative*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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