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Table of Contents
Vol. 20, No. 4, 2005
Issue release date: July–August 2005
Section title: Paper
Fetal Diagn Ther 2005;20:316–320
(DOI:10.1159/000085093)

Impact of Continuous Intraoperative Monitoring on Outcomes in Open Fetal Surgery

Keswani S.G. · Crombleholme T.M. · Rychik J. · Tian Z. · MacKenzie T.C. · Johnson M.P. · Wilson R.D. · Flake A.W. · Hedrick H.L. · Howell L.J. · Adzick N.S.
Center for Fetal Diagnosis and Treatment and Fetal Heart Program at the Children’s Hospital of Philadelphia, Philadelphia, Pa., USA

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Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 7/13/2004
Accepted: 1/7/2005
Published online: 6/16/2005

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 2

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT

Abstract

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.


Article / Publication Details

First-Page Preview
Abstract of Paper

Received: 7/13/2004
Accepted: 1/7/2005
Published online: 6/16/2005

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 2

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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    External Resources

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